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【Objective】 To establish a model for predicting the risk of urinary incontinence after holmium laser enucleation of the prostate (HoLEP). 【Methods】 The clinical data of 258 patients with benign prostatic hyperplasia (BPH) who underwent HoLEP in our hospital during Jan.2019 and Feb.2022 were retrospectively analyzed. According to the occurrence of urinary incontinence after surgery, they were divided into the urinary incontinence group (n=84) and non-urinary incontinence group (n=174). Lasso regression was used to screen the predictors of urinary incontinence after HoLEP. Logistic regression was used to establish a suitable model, and a nomogram of urinary incontinence after HoLEP was drawn. Bootstrap was used to verify and draw the calibration curve of the model, calculate the C index, and draw the clinical decision curve to further verify the accuracy and identification ability of the model. 【Results】 Predictors including International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), body mass index (BMI), diabetes, prostate volume (PV), and prostate-specific antigen (PSA) were selected, based on which a prediction model was constructed. The area under the receiver operating characteristic (ROC) curve of the prediction model was 0.766 0, and the 95% confidence interval was 0.704-0.828. Bootstrap internal validation showed a C-index of 0.766 2, and the calibration model curve coincided well with the actual model curve. The clinical decision curve analysis showed that the model had high accuracy, and net benefit in the probability of urinary incontinence was within 10% to 82%. 【Conclusion】 IPSS, QoL, diabetes, prostate volume, and PSA are predictors that can affect the occurrence of urinary incontinence after HoLEP. The model has high accuracy, identification ability and net benefit.
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【Objective】 To compare the efficacy and safety of thulium laser enucleation of the prostate (ThULEP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in PubMed, Embase, Cochrane Library, CNKI and Wanfang Database from Jan.1,2010 to May 30,2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. All divergences were resolved by a third researcher. RevMan 5.4 software was used for Meta analysis. 【Results】 A total of 7 studies were included, involving 1 726 patients, 750 in the ThULEP group and 976 in the HoLEP group. Meta analysis showed that, compared with HoLEP group, the ThULEP group had shorter catheter indwelling time [MD=-0.10, 95%CI (-0.17--0.03), P=0.004] , shorter hospital stay [MD=-0.43, 95%CI (-0.60--0.25), P<0.000 01] , lower IPSS score 12 months after surgery [MD=-1.13, 95%CI (-1.95- -0.30), P=0.007] , lower QoL score 12 months after surgery [MD=-1.00, 95%CI (-1.19- -0.81), P<0.001] ,lower transfusion rate [OR=0.11, 95%CI (0.03-0.36), P=0.000 3] and lower incidence of urinary incontinence [OR=0.24, 95%CI (0.09-0.66), P=0.006] . 【Conclusion】 ThULEP may have similar efficacy and safety as HoLEP in the treatment of BPH, and has more advantages in some aspects.
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Objective : To study the effect of modified holmium laser enucleation of the prostate (HoLEP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods ¡¤ The clinical data of 167 middle-aged and elderly patients with BPH treated by modified HoLEP from Feb. 2017 to Oct. 2018 were retrospectively analyzed. According to the status of sexual activity after operation, the patients were divided into study group who had sex (65 cases) and control group who had no sex (102 cases). The risk factors of sexual activity after operation in the two groups were analyzed. The changes of erectile function and ejaculatory function in the study group before and after operation were recorded and analyzed by international index of erectile function (IIEF-5) score, erection hardness score (EHS) model and ejaculatory function question-naire. Results ¡¤ There were no significant differences between the two groups in the stress urinary incontinence, postoperative hospitalization time, weight of enucleated prostate, crush time, total prostate specific antigen, preoperative urinary retention and enucleation time. The patients in the study group were younger than those in the control group (P=0.000). There were no significant differences in IIEF-5 score and EHS in the study group before and 1, 3, 6 months after operation. There were no significant differences in shorten ejaculation latency, ejaculation pain and ejaculation with or without semen in the study group before and after operation, but the patients of decreased semen volume increased from 41.82% (23/55) to 92.73% (51/55) (P=0.000). Conclusion ¡¤ Age is a risk factor in BPH patients, whether there is sexual activity after modified HoLEP or not. The modified HoLEP has no significant effect on erectile function, but the effect on ejaculatory function is the decrease of ejacu-lated semen volume.
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Objective@#To assess the clinical effects of transurethral holmium laser enucleation of the prostate (HoLEP) combined with Jisheng Shenqi Decoction (HoLEP + JSSD) on BPH.@*METHODS@#This study included 110 BPH patients treated in our hospital from August 2017 to April 2018, who were randomly assigned to receive HoLEP (n = 55) or HoLEP + JSSD (n = 55). We compared the pre- and post-operative IPSS, quality of life (QOL) score, prostate volume, postvoid residual urine volume (PVR), maximum urinary flow rate (Qmax), average urinary flow rate (Qavg) and levels of serum T, E2 and T/E2 as well as postoperative complications between the two groups of patients.@*RESULTS@#After treatment, both IPSS and QOL score were significantly lower in the HoLEP + JSSD than in the HoLEP group (P 0.05) or the total incidence rate of complications postoperatively (21.82% vs 29.09%, P > 0.05).@*CONCLUSIONS@#HoLEP + JSSD can significantly alleviate the lower urinary tract symptoms as well as improve the QOL and bladder and urinary tract functions of BPH patients.
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Objective@#To evaluate the efficiency and safety of transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of BPH in patients with a history of transrectal prostate biopsy (TRPB).@*METHODS@#We retrospectively analyzed the clinical data on 102 cases of BPH treated by HoLEP in our hospital between November 2015 and May 2017, of which 42 had received TRPB prior to HoLEP (the PB group) but not the other 60 (the non-TRPB ［NPB］ group). We compared the preoperative, perioperative and postoperative follow-up data between the two groups of patients.@*RESULTS@#There were no statistically significant differences in the mean age, prostate volume, and preoperative post-void residual urine volume (PVR), IPSS, quality of life (QOL) score and maximum urinary flow rate (Qmax) between the two groups of patients. The preoperative PSA level was significantly higher in the PB than in the NPB group (［10.30 ± 3.62］ vs ［2.62 ± 1.75］ μg/L, P < 0.01), and the operation time markedly longer in the former than in the latter (［78.00 ± 18.25］ vs ［67.93 ± 15.89］ min, P < 0.01), particularly in the patients with an interval of <2 weeks between HoLEP and TRPB than in those with an interval of ≥2 weeks (［91.17 ± 16.51］ vs ［68.13 ± 12.45］ min, P < 0.01). Statistically significant differences were not found in the postoperative hemoglobin level, continuous bladder irrigation duration, catheter-indwelling time and hospital stay, nor in the incidence rate of transient urinary incontinence between the PB and NPB groups (47.62% vs 45%, P = 0.794). There were no transurethral resection syndrome, bladder or rectal injury, or blood transfusion in either group, nor statistically significant differences in PVR, Qmax, IPSS and QOL score between the two groups of patients at 3, 6 or 12 months after operation.@*CONCLUSIONS@#HoLEP is a safe and effective surgical treatment of BPH for patients with a history of TRPB, which can reduce the time and increase the safety of operation when performed at ≥2 weeks after TRPB.
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Benign prostatic hyperplasia (BPH) is a common disease in the elderly population and holmium laser enucleation of the prostate (HoLEP) is an important method for its management. However, postoperative complications of HoLEP affects the patients' quality of life as well as the outcome of surgery. Based on the ten-year clinical practice and multi-center data analysis, the author puts forward the concept of "postoperative urethral recovery" for BPH patients receiving HoLEP, which involves postoperative pain recovery, urination recovery, urine control recovery, sexual function recovery, and a postoperative recovery system aiming at the acceleration of recovery.
Subject(s)
Aged , Humans , Male , Holmium , Laser Therapy , Methods , Lasers, Solid-State , Pain, Postoperative , Postoperative Period , Prostatectomy , Methods , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Sexual Behavior , Treatment Outcome , Urethra , Physiology , UrinationABSTRACT
Objective@#To investigate the clinical effect of "3+1" bladder function restoration combined with holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with acontractile detrusor (ACD).@*METHODS@#We treated 35 BPH patients with ACD by HoLEP followed by "3+1" bladder function restoration, that is, a 3-phase bladder function training plus simultaneous 1-drug medication after surgery. We recorded and analyzed the detrusor pressure, post-void residual urine volume (PVR), maximum urinary flow rate (Qmax), International Prognostic Scoring System (IPSS) scores, quality of life (QoL), voluntary micturition, satisfaction with the bladder function, hydronephrosis, ureterectasia, renal function, and urinary tract infection of the patients before and after treatment.@*RESULTS@#Compared with the base line, at 6 months treatment, the patients showed significantly increased detrusor pressure (［35.1±2.7］vs ［50.2±2.3］ cmH2O, P<0.05) and Qmax (［4.2±2.7］vs ［21.1±4.1］ ml/s, P<0.05) but decreases in PVR (［173.0±31.6］ vs ［30.5±12.9］ml, IPSS score (27.3±3.2 vs 5.1±1.4, P<0.05) and QoL (4.1±0.8 vs 0.8±0.1, P<0.05), elevated rates of voluntary urination (0% ［0/35］ vs 100% ［35/35］, P<0.05), regularurination (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), grade Ⅰ satisfaction with bladder function (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), reduced rate of overflowing urinary incontinence (28.57% ［10/35］ vs 5.71% ［2/35］, P<0.05), and increased percentages of normal renal function (34.29% ［12/35］ vs 85.71% ［30/35］, P<0.05) and non-infection of the urinary system (17.14% ［6/35］ vs 94.29% ［33/35］, P<0.05). After treatment, urination was markedly improved in 94.29% (33/35) of the patients.@*CONCLUSIONS@#"3+1" bladder function restoration combined with HoLEP produced a desirable effect on BPH with ACD, though its long-term effect remains to be further investigated.
Subject(s)
Aged , Humans , Male , Holmium , Laser Therapy , Methods , Lasers, Solid-State , Personal Satisfaction , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder , Physiology , Urination , PhysiologyABSTRACT
<p><b>Objective</b>To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.</p><p><b>METHODS</b>his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.</p><p><b>RESULTS</b>There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.</p>
Subject(s)
Humans , Male , Lasers, Solid-State , Therapeutic Uses , Length of Stay , Prostate , General Surgery , Prostatic Hyperplasia , General Surgery , Quality of Life , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder Neck Obstruction , General Surgery , Urinary Bladder, Overactive , General Surgery , Urinary Catheterization , Urination , PhysiologyABSTRACT
<p><b>Objective</b>To evaluate the safety and effect of transurethral holmium laser enucleation of the prostate (HoLEP) in comparison with bipolar transurethral plasmakinetic prostatectomy (TUPKP) in the treatment of benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>We searched the databases of PubMed, SCI, Ovid, The Cochrane Library, CNKI, CBM, VIP, and Wangfang Data for controlled clinical trials about HoLEP versus TUPKP in the treatment of BPH published up to April 2016. The studies were screened according to the inclusion and exclusion criteria, the data extracted, and their quality evaluated by 2 reviewers independently, followed by a meta-analysis using the RevMan 5.3 software.</p><p><b>RESULTS</b>A total of 7 studies were included, involving 2031 cases. In comparison with TUPKP, HoLEP showed significantly longer operation time (WMD = 24.61, 95% CI 11.88, 37.34, P lt; 0.001), shorter hospital stay (WMD =－1.91, 95% CI －3.74, －0.07, P = 0.04), shorter bladder irrigation time (WMD = －21.50, 95% CI －34.95, －8.06, P = 0.002), shorter catheter-indwelling time (WMD = －27.60, 95% CI －48.17, －7.03, P = 0.009), less hemoglobin loss (WMD = － 0.42, 95% CI －0.78, －0.07, P = 0.02); lower postvoid residual urine (PVR) at 3 months (WMD = －3.35, 95% CI －4.46, －2.23, P<0.001) and 6 months after surgery (WMD =－1.11, 95% CI －2.18, －0.05, P = 0.04); higher maximum urinary flow rate (Qmax) (WMD = 0.42, 95% CI 0.04, 0.80, P = 0.03) and fewer urinary tract irritation symptoms (OR =0.58, 95% CI 0.41, 0.81, P = 0.002) at 12 months after surgery. No statistically significant differences were found between the two groups in the volume of resected tissue, serum sodium reduction, urethral stricture, erectile dysfunction, retrograde ejaculation, or transient urinary incontinence (P>0.05), or in the improvement of the quality of life (QoL) at 1, 3 and 12 months, International Prostate Symptom Score (IPSS) at 1, 3, 6 and 12 months, Qmax at 1, 3 and 6 months, or International Index of Erectile Function-5 (IIEF-5) at 6 months after surgery (P>0.05).</p><p><b>CONCLUSIONS</b>HoLEP is preferred to TUPKP in clinical application for its advantages of higher Qmax at 12 months after surgery, lower PVR at 3 and 6 months, higher peri-operative safety, faster recovery, and fewer urinary tract irritation symptoms. However, for the quantity and quality limitations of the included publications, our findings are to be further supported by large-sample, multi-center, and high-quality prospective controlled clinical studies.</p>
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<p><b>Objective</b>To evaluate the efficiency and safety of the modified versus conventional morcellation procedure in holmium laser enucleation of the prostate (HoLEP).</p><p><b>METHODS</b>We treated 195 patients with benign prostatic hyperplasia (BPH) by HoLEP, using conventional morcellation for 100 cases and modified morcellation for the other 95. We recorded the morcellation time, the total volume of resected tissue, the rate of morcellation, and associated complications, and compared the data obtained between the two groups.</p><p><b>RESULTS</b>The volumes of resected tissue were similar between the conventional and modified morcellation groups (［72.3±19.8］ vs ［71.1±17.7］ g, P>0.05). The morcellation time was significantly longer in the conventional than in the modified morcellation group (［12.8±2.8］ vs ［8.5±2.0］ min, P<0.01), and the morcellation rate was remarkably lower in the former than in the latter (［4.9±1.4］ vs ［7.1±0.9］ g/min, P<0.01). No statistically significant differences were observed in the incidence of complications, bladder injury for instance, between the two groups of patients.</p><p><b>CONCLUSIONS</b>The modified morcellation procedure can be used for mocellation of various types of tissue, with a higher efficiency than the conventional technique, and therefore deserves wide clinical application.</p>
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Objective:To evaluate the safety and clinical effect of holmium laser enucleation of the prostate (HoLEP) for pati-ents with benign prostatic hyperplasia (BPH) .Methods:A total of 40 patients with BPH from Jan 2015 to Jul 2015 were underwent HoLEP.Pre-and postoperative complication were recorded and the differences of the clinical parameters were also compared, including peak urinary flow rate (Qmax), residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QOL) .Results:A total of 34 patients were included after operation and 6 patients lost to follow-up. Qmax, PVR, IPSS, QOL after three months postoperatively were improved significantly compared with that of preoperative (P<0.01) .Complications included intraoperative bladder injury (1 case), postoperative stress incontinence (2 cases), urethral stricture (1 case) .No patients experienced the sign of TUR syndrome and blood transfusion for severe bleeding.Conclusion:HoLEP has the advantage of good therapeutic effects,wide scope of application,better safety performance,smaller risk and it’s worth popularizing in primary hospitals.
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Objective To evaluate and compare the efficacy of holmium laser enucleation of the prostate(HoLEP) and plasmakineticenucleation of the prostate(PKEP) for treating benign prostatic hyperplasia (BPH).Methods A total of 86 cases of BPH were selected from the Shandong Energy Zibo Mining Group Co.Ltd Central Hospital from January 2013 to June 2014.The patients received either HoLEP (40 cases) or PKEP(46 cases) treatment.Clinical data including postvoid residual volume (PVR),international prostate symptom score(IPSS),quality-of-life score(QOL score),maximum urinary flow rate (MFR) were evaluated before and 3 months after operation.Blood loss in operation,operation time,weight of resected prostate tissue,bladder irrigation time,catheterization time and length of hospital stay were also collected from the perioperative period.Results Three months after surgery,PVR,IPSS,QOL and MFR were all significantly improved in both HoLEP and PKEP groups compared with the data before operation (P =0.000),while there was no significant difference between the two groups(P＞0.05).Patients from the HoLEP group showed markedly lower values of bone loss in operation than that of PKEP group((69.5±23.6) ml vs.(87.5±38.0) ml,P=0.011).There were no significant differences in terms of other indexes (P＞ 0.05).Conclusion HoLEP and PKEP have similar efficiency in treating BPH,while HoLEP is suggested superior in regard of bone loss.
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Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
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Holmium , Lasers, Solid-State , Learning Curve , Prostate , Prostatectomy , Prostatic HyperplasiaABSTRACT
Objectve To study the techniques and clinical effect of transurethral holmium laser enucleation of the prostate (HoEAP) and prostatic tissue morcellation. Methods 61 patients of benign prostate hyperplasia(BPH) were operated on HoEAP with high power 100 w holmium laser and prostatic tissue morcellation with tissue morcellator. Results All the patients successed.The operation time of resected prostate was (25～68) min The tissue weight of resected prostate was (25～66)gm.The morcellation time of tissue was (20～90) min.All the patients got normal micturition after urethral indwelling catheter(16～96) hours.All patients had been followed up for 2 months to 8 months with a mean ot 5 months.Acording to Symptemic Scores.(I-PSS),the results of therapy were assessed as follows:excellent in 54(65.8%),good in 16 (19.5%),moderate in 12(14.6%). Conclusion The techniqne of HoEAP and prostate tissue morcellation can provide accurate,safe and faster cutting with less blood loss.A reliabe tissue morcellation and shorten operation time remarkebly are obtained.Postoperation results show a prompt unobstructed,effect.