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1.
Int. braz. j. urol ; 48(1): 200-201, Jan.-Feb. 2022.
Article in English | LILACS | ID: biblio-1356299

ABSTRACT

ABSTRACT Purpose: The expansion of technology is leading to a paradigm shift in several urological fields (1, 2). In particular, the adoption of lasers within the surgical treatment of patients with benign prostatic hyperplasia (BPH) is considered one of the most relevant innovations (3-5). In this video, we aimed to report our experience with holmium laser for the ablation of the prostate (HoLAP) in patients with obstructive lower urinary tract symptoms (LUTS) due to BPH. Materials and Methods: From 2018 to 2020, 10 patients with obstructive LUTS secondary to BPH were treated at our Institution with HoLAP (120W Holmium laser Lumenis® with Moses® technology). Main inclusion criteria were: 1) International Prostate Symptom Score ≥12; 2) prostate volume ≤65mL, 3) maximal flow rate (Qmax) ≤15ml/s at preoperative non-invasive uroflowmetry. Results: Mean patient age was 65 (range: 59-72) years. Preoperative mean prostate volume was 50 (range: 35-65) mL. Mean operative time was 66 (range: 45-85) minutes with a mean laser time/operative time ratio of 0.51 (range: 0.44-0.60). Voiding symptoms, Qmax and post voiding residual were significantly improved after 3 and 12 months (all p <0.05). No postoperative urinary incontinence was detected. Conclusions: The present findings suggest that HoLAP is a slightly time-spending procedure, thus its use should be limited to prostate volume <70-80mL. However, no postoperative complications were recorded at all. This technique showed to be a safe option in patients with low-intermediate prostate volume, also in patients whose antiaggregant/anticoagulant therapy is maintained.


Subject(s)
Humans , Male , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate , Laser Therapy , Lasers, Solid-State/therapeutic use , Prostate/surgery , Prostatectomy , Technology , Holmium
2.
National Journal of Andrology ; (12): 888-894, 2020.
Article in Chinese | WPRIM | ID: wpr-880287

ABSTRACT

Objective@#To investigate the advantages and disadvantages of point electro-cauterization (PEC) and holmium laser cauterization (HLC) in the treatment of post-ejaculation hematuria.@*METHODS@#From January 2015 to December 2018, 73 patients with post-ejaculation hematuria, aged 24-63 (36.8 ± 4.2) years, underwent PEC (n = 35) or HLC (n = 38) after failure to respond to 3 months of conservative treatment. We compared the hospital days, total hospitalization expenses, maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Hamilton Anxiety Rating Scale (HAMA) score, postoperative duration of hematuria, and recurrence rate at 3 and 6 months after surgery.@*RESULTS@#All the patients experienced first ejaculation but no post-ejaculation hematuria at 1 month after operation. The recurrence rates were lower in the PEC than in the HLC group at 3 months (5.71% vs 2.63%, P > 0.05) and 6 months postoperatively (8.57% vs 5.26%, P > 0.05). Compared with the baseline, the Qmax was decreased from (18.56 ± 2.53) ml/s to (13.68 ± 3.31) ml/s (P < 0.05) and the Qavg from (14.35 ± 2.26) ml/s to (9.69±1.84) ml/s in the PEC group at 1 month after surgery (P < 0.01), but neither showed any statistically significant difference in the HLC group. Mild to moderate anxiety was prevalent in the patients preoperatively, particularly in those without job or regular income and those with a long disease course or frequent onset, the severity of which was not correlated with age, education or marital status. The HAMA score was decreased from18.65 ± 4.33 before to 12.35 ± 3.63 after surgery in the PEC group (P < 0.01), and from 16.88 ± 2.11 to 6.87 ± 4.36 in the HLC group (P < 0.01). The mean hospital stay was significantly longer in the former than in the latter group ([5.2 + 1.3] vs [3.4 ± 0.5] d, P < 0.01), while the total cost markedly lower ([6.35 ± 1.20] vs [12.72 ± 2.15] thousand RMB ¥, P < 0.05).@*CONCLUSIONS@#Both PEC and HLC are safe and effective for the treatment of post-ejaculation hematuria, with no significant difference in the recurrence rate at 3 and 6 months after operation, but their long-term effect needs further follow-up studies. PEC may increase the risk of negative outcomes of the postoperative urinary flow rate, while HLC has the advantages of better relieving the patient's anxiety, sooner discharge from hospital and earlier recovery from postoperative hematuria, though with a higher total cost than the former.


Subject(s)
Adult , Cautery , Ejaculation , Hematuria/surgery , Holmium , Humans , Laser Therapy , Lasers, Solid-State/therapeutic use , Male , Middle Aged , Treatment Outcome , Young Adult
3.
Article in English | WPRIM | ID: wpr-764099

ABSTRACT

PURPOSE: To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum (PNV) after Holmium laser enucleation of the prostate (HoLEP). METHODS: From January 2016 to April 2018, a total of 93 consecutive patients treated with HoLEP were enrolled in this study. For tissue morcellation, we used the PNV morcellation technique for an initial series of 21 patients and the conventional technique (Lumenis VersaCut) for a consecutive series of 72 patients. We compared efficiency and safety between the novel technique and the traditional technique. Subgroup analysis was performed to assess the effectiveness of the current technique in the large prostate (>70 mL). RESULTS: There were significant differences in mean age and prostate volume between the 2 groups. However, there were no significant differences in the baseline characteristics and preoperative parameters in the subgroup analysis of large prostates (>70 mL). The mean morcellation efficiency was higher (8.50±1.94 minutes vs. 1.76±0.45 minutes, P<0.05) and the time of morcellation (7.81±1.25 minutes vs. 34.04±11.14 minutes, P<0.05) was shorter in the PNV group. Moreover, there were no significant differences between groups in hospitalization period (2.62±1.10 days vs. 2.90±1.26 days, P=0.852) and any other postoperative events, including recatheterization, reoperation, clot retention, and urethral stricture (P-value range, 0.194–0.447). In the PNV group, there were some cases of procedure-related complications, including postoperative extravesical leakage (5th case), clot retention (8th case), and recatheterization (9th case). CONCLUSIONS: This method has a higher tissue retrieval efficacy, with the advantage of excellent visibility compared to conventional morcellation. The current method can be applied when a transurethral morcellator is out of order or cannot be used.


Subject(s)
Adenoma , Holmium , Hospitalization , Humans , Lasers, Solid-State , Methods , Morcellation , Prostate , Prostatic Hyperplasia , Reoperation , Urethral Stricture
4.
National Journal of Andrology ; (12): 525-528, 2018.
Article in Chinese | WPRIM | ID: wpr-689697

ABSTRACT

<p><b>Objective</b>To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.</p><p><b>METHODS</b>This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.</p><p><b>RESULTS</b>Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10-55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6-20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.</p><p><b>CONCLUSIONS</b>The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.</p>


Subject(s)
Calculi , Diagnostic Imaging , General Surgery , Ejaculatory Ducts , Endoscopes , Endoscopy , Genital Neoplasms, Male , Hemospermia , Diagnosis , Therapeutics , Holmium , Humans , Lasers, Solid-State , Lithotripsy , Magnetic Resonance Imaging , Male , Natural Orifice Endoscopic Surgery , Neoplasm Recurrence, Local , Postoperative Complications , Reproducibility of Results , Seminal Vesicles , Diagnostic Imaging , Urethra
5.
Article in English | WPRIM | ID: wpr-742342

ABSTRACT

PURPOSE: To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy. MATERIALS AND METHODS: One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency. RESULTS: The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not. CONCLUSIONS: When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.


Subject(s)
Holmium , Humans , Lasers, Solid-State , Learning Curve , Prostate , Prostatic Hyperplasia
6.
Article in English | WPRIM | ID: wpr-716838

ABSTRACT

PURPOSE: To investigate factors associated with early recovery of stress urinary incontinence (SUI) following holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic enlargement (BPE). METHODS: The medical records of 393 patients who underwent HoLEP for BPE were retrospectively reviewed. Patients with SUI following HoLEP were selected and divided into 2 groups: those who experienced early recovery of SUI and those who experienced persistent SUI. Recovery of SUI within 1 month after HoLEP was defined as early, and SUI that remained present after 1 month was defined as persistent. Preoperative clinical and urodynamic factors, as well as perioperative factors, were compared between groups. RESULTS: SUI following HoLEP was detected in 86 patients. Thirty-three patients exhibited recovery of SUI within 1 month, and SUI remained present in 53 patients after 1 month. Multivariate analysis showed that the transition zone prostate volume (odds ratio [OR], 5.354; 95% confidence interval [CI], 1.911–14.999; P=0.001) and the enucleation ratio (OR, 8.253; 95% CI, 1.786–38.126; P=0.007) were significantly associated with early recovery of SUI. CONCLUSIONS: Early recovery of SUI within 1 month following HoLEP was associated with transition zone prostate volume and the enucleation ratio.


Subject(s)
Holmium , Humans , Lasers, Solid-State , Medical Records , Multivariate Analysis , Prostate , Prostatic Hyperplasia , Retrospective Studies , Urinary Incontinence , Urodynamics
7.
National Journal of Andrology ; (12): 99-103, 2018.
Article in Chinese | WPRIM | ID: wpr-775213

ABSTRACT

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 , Holmium , Humans , Laser Therapy , Methods , Lasers, Solid-State , Male , Pain, Postoperative , Postoperative Period , Prostatectomy , Methods , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Sexual Behavior , Treatment Outcome , Urethra , Physiology , Urination
8.
National Journal of Andrology ; (12): 912-916, 2017.
Article in Chinese | WPRIM | ID: wpr-812857

ABSTRACT

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 , Holmium , Humans , Laser Therapy , Methods , Lasers, Solid-State , Male , Personal Satisfaction , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder , Physiology , Urination , Physiology
9.
Article in English | WPRIM | ID: wpr-19905

ABSTRACT

PURPOSE: Currently, holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the standard surgical procedures used to treat benign prostatic hyperplasia (BPH). Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU) can effectively improve voiding symptoms, but comparative data on the efficacy of HoLEP and TURP are insufficient. Therefore, we compared the short-term surgical outcomes of HoLEP and TURP in patients with DU. METHODS: From January 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32). Surgical outcomes were retrospectively compared between the 2 groups. DU was defined as a detrusor pressure at maximal flow rate of <40 cm H(2)O as measured by a pressure flow study. RESULTS: The preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups. The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033). The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group. CONCLUSIONS: HoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.


Subject(s)
Comorbidity , Holmium , Humans , Lasers, Solid-State , Lower Urinary Tract Symptoms , Operative Time , Prostate , Prostatic Hyperplasia , Retrospective Studies , Transurethral Resection of Prostate
10.
Article in Korean | WPRIM | ID: wpr-18766

ABSTRACT

OBJECTIVE: Holmium laser enucleation of prostate (HoLEP) is as fast-paced treatment that is one of the standard treatment for benign prostate hypoplasia. However, there is a rare case that the satisfaction rate of surgery is lowered due to storage symptoms such as frequency and urgency. We investigated the risk factors of bladder irritation symptoms persisted after holmium laser enucleation of prostate. METHODS: From January 2009 to December 2014, 220 patients underwent HoLEP in Soonchunhyang University Cheonan Hospital. Among them, 133 patients were selected who did not have any problem that could affect the voiding function including urologic cancer, neurogenic bladder, urinary tract infection, and bladder stone disease. At 3 months after surgery patients were divided into two groups: postoperative International Prostate Symptom Score (IPSS) storage symptom scores <8 (group I) and ≥8 (group II). The two groups were analyzed the parameters: preoperative (prostate size, uroflowmetry, IPSS, prostate calcification), intraoperative (operative time, resected prostate weight), and postoperative (IPSS, uroflowmetry). RESULTS: Of the 133 patients, 94 patients were assigned to group I and 39 patients were group II. Age of the patients, the prostate size, and maximal urinary flow rate showed no statistical difference in both groups. Preoperative storage symptom scores were significantly higher in group II (P<0.05) and IPSS voiding-to-storage subscore ratio was lower in group II without significance (P<0.05). The prostate calcification, periurethral prostatic calcification, and intravesical prostatic protrusion was no difference in the two groups. Postoperative IPSS, maximal urinary flow rate, and post-void residual urine volume was improved in two groups but storage symptom score was not improved in group II. Operative time and resected prostate weight were not found the differences, and postoperative parameters (maximal urinary flow rate, post-void residual urine volume) were showed no difference in both groups. However all of the IPSS was higher in group II. CONCLUSION: Many symptom improvements after HoLEP were observed but some patients may have difficulties due to persistent bladder irritation. Because bladder irritation sign could persist after surgery if preoperative storage symptom score was higher, it is necessary for a detailed description before surgery.


Subject(s)
Holmium , Humans , Lasers, Solid-State , Operative Time , Prostate , Prostatectomy , Risk Factors , Urinary Bladder , Urinary Bladder Calculi , Urinary Bladder, Neurogenic , Urinary Tract Infections , Urologic Neoplasms
11.
Article in English | WPRIM | ID: wpr-222837

ABSTRACT

PURPOSE: We investigated the effects of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate (≤30 mL) in whom medical treatment was ineffective. MATERIALS AND METHODS: Data from 132 patients who underwent HoLEP by a single surgeon between 2012 and 2015 were retrospectively analyzed. All patients received benign prostatic hyperplasia medication for at least 6 months before surgery. The patients were divided into 2 groups according to prostate size: group 1, ≤30 mL (n=30); and group 2, >30 mL (n=102). Clinical characteristics and the International Prostate Symptom Score (IPSS), including quality of life (QoL), peak urinary flow rate (Qmax), and postvoid residual urine (PVR), before surgery and 3 months postoperatively, were compared between the 2 groups. RESULTS: In group 1, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. The voiding subscore also significantly decreased 3 months after surgery (p < 0.001), but the storage subscore was not significantly different (p=0.055). In group 2, hemoglobin, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. In these patients, both the storage subscore and voiding subscore significantly decreased after surgery (both p < 0.001). There were no significant differences between the groups in hemoglobin, IPSS, QoL, Qmax, and PVR either before or 3 months after surgery. CONCLUSIONS: When other medical treatments are ineffective, HoLEP is an effective intervention for patients with a small prostate.


Subject(s)
Holmium , Humans , Lasers, Solid-State , Prostate , Prostatic Hyperplasia , Quality of Life , Retrospective Studies , Transurethral Resection of Prostate , Treatment Outcome
12.
Article in Korean | WPRIM | ID: wpr-156629

ABSTRACT

Benign prostatic hyperplasia (BPH) is one of the most common urological diseases in men after middle age. The most common surgical treatment of BPH is transurethral prostatectomy. Recently, because of the rapid development of lasers, they have been used for the treatment of BPH. The treatment of BPH using lasers has been shown to lead to significant improvements in symptoms and to have excellent therapeutic effects. It is widely used as a minimally invasive treatment of BPH because of the risk and complications associated with transurethral prostate resection. Currently, 3 kinds of lasers are generally used in the treatment of BPH in Korea: potassium-titanyl-phosphate, holmium, and thulium lasers. With developments in laser technology, surgical procedures have improved continuously. The most common surgical procedures are holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate (PVP), and thulium laser enucleation of the prostate. HoLEP is an effective surgical procedure for large prostates. PVP is safe for patients who are elderly, are in poor general health, or are taking anticoagulants. Thulium laser enucleation of prostate has advantages over PVP and HoLEP surgery due to specific characteristics of the laser and the surgical method. Compared with transurethral prostate resection, laser-based surgical procedures require shorter hospitalization and Foley catheter insertion periods. HoLEP and PVP are safe and effective methods for the surgical treatment of BPH. Therefore, if more data are accumulated from research into these methods, they will become the standard surgical treatments for prostate hyperplasia.


Subject(s)
Aged , Anticoagulants , Catheters , Holmium , Hospitalization , Humans , Hyperplasia , Korea , Lasers, Solid-State , Male , Methods , Middle Aged , Prostate , Prostatic Hyperplasia , Therapeutic Uses , Thulium , Transurethral Resection of Prostate , Urologic Diseases , Volatilization
13.
Int. braz. j. urol ; 42(4): 740-746, July-Aug. 2016. tab
Article in English | LILACS | ID: lil-794683

ABSTRACT

ABSTRACT Purpose: To determine the predictive factors for postoperative urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP) during the initial learning period. Patients and Methods: We evaluated 127 patients with benign prostatic hyperplasia who underwent HoLEP between January 2011 and December 2013. We recorded clinical variables, including blood loss, serum prostate-specific antigen levels, and the presence or absence of UI. Blood loss was estimated as a decline in postoperative hemoglobin levels. The predictive factors for postoperative UI were determined using a multivariable logistic regression analysis. Results: Postoperative UI occurred in 31 patients (24.4%), but it cured in 29 patients (93.5%) after a mean duration of 12 weeks. Enucleation time >100 min (p=0.043) and blood loss >2.5g/dL (p=0.032) were identified as significant and independent risk factors for postoperative UI. Conclusions: Longer enucleation time and increased blood loss were independent predictors of postoperative UI in patients who underwent HoLEP during the initial learning period. Surgeons in training should take care to perform speedy enucleation maneuver with hemostasis.


Subject(s)
Humans , Male , Aged , Prostate/surgery , Prostatic Hyperplasia/surgery , Urinary Incontinence/etiology , Transurethral Resection of Prostate/adverse effects , Lasers, Solid-State/therapeutic use , Postoperative Period , Body Mass Index , Logistic Models , Multivariate Analysis , Risk Factors , Prostate-Specific Antigen/blood , Learning Curve , Holmium
14.
Journal of Lasers in Medical Sciences. 2016; 7 (1): 12-15
in English | IMEMR | ID: emr-178963

ABSTRACT

Introduction: To assessment of the efficacy and safety of transurethral Cystolithotripsy of large bladder stones by holmium laser in the outpatient setting


Methods: In a prospective study 48 consecutive adult patients with large bladder stones, were enrolled for transurethral Cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded


Results: Patients mean age was 46 +/- 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 +/- 3.5. Mean stone size was 3.7 +/- 1.6 cm. Mean operation time was 43.5 +/- 15.5 minutes. Nearly complete stone clearance [98.5%] was achieved in all patients. Mean hospital stay was 6.5 +/- 1.3 hours. No major complications were seen. Mean visual analog pain score [VAS] was 4.2 +/- 2.1 and 1.4 +/- 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 +/- 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected


Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lasers, Solid-State , Prospective Studies , Lithotripsy, Laser , Holmium
15.
Article in English | WPRIM | ID: wpr-63256

ABSTRACT

PURPOSE: To evaluate the effect of age on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS: A total of 579 patients underwent HoLEP procedure performed by a single surgeon (SJO) between December 2009 and May 2013. The perioperative and functional outcomes of patients in the age groups of 50-59 (group A, n=44), 60-69 (group B, n=253), 70-79 (group C, n=244), and ≥80 years (group D, n=38) were compared. The Clavien-Dindo system was used to evaluate clinical outcomes. The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR) urine volume, and urinary continence were used to assess functional outcomes. RESULTS: In this study, the patients ≥80 years had significantly higher presence of hypertension (P=0.007), total prostate volumes (P=0.024), transitional zone volume (P=0.002), American Society of Anesthesiologists scores (P=0.006), urinary retention (P=0.032), and anticoagulation use (P=0.008) at preoperative period. Moreover, the mean values of operation time, enucleation time, morcellation time, and enucleation weight were higher in group D compared with other group patients (P=0.002, P=0.010, P0.05). All the patients in the present study showed improvement in functional outcomes after HoLEP. By the sixth month, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (P>0.05). CONCLUSIONS: Compared with younger patients, the patients aged ≥80 years had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.


Subject(s)
Aged , Holmium , Humans , Hypertension , Incidence , Laser Therapy , Lasers, Solid-State , Length of Stay , Morcellation , Preoperative Period , Prospective Studies , Prostate , Prostatic Hyperplasia , Quality of Life , Transurethral Resection of Prostate , Urinary Retention
16.
Article in English | WPRIM | ID: wpr-32089

ABSTRACT

PURPOSE: To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. METHODS: Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases) and experienced (≥21 cases). RESULTS: Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis. CONCLUSIONS: Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient's quality of life with regards to urinary continence.


Subject(s)
Catheters , Holmium , Humans , Lasers, Solid-State , Learning Curve , Learning , Mentors , Multivariate Analysis , Odds Ratio , Prostate , Quality of Life , Transurethral Resection of Prostate , Urinary Incontinence , Urodynamics
17.
Korean Journal of Urology ; : 150-156, 2015.
Article in English | WPRIM | ID: wpr-109960

ABSTRACT

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.


Subject(s)
Abscess/etiology , Aged , Aged, 80 and over , Calcinosis/complications , Drainage/methods , Holmium , Humans , Lasers, Solid-State/therapeutic use , Male , Middle Aged , Prostatic Diseases/etiology , Retrospective Studies , Tomography, X-Ray Computed , Transurethral Resection of Prostate/methods , Treatment Outcome , Urinary Bladder Neck Obstruction/complications
18.
Korean Journal of Urology ; : 218-226, 2015.
Article in English | WPRIM | ID: wpr-60931

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. MATERIALS AND METHODS: Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV or =200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery. RESULTS: A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, +/-7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7+/-36.9 mL and 4.15+/-4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. CONCLUSIONS: HoLEP in patients with an extremely large prostate can be performed efficiently and safely.


Subject(s)
Aged , Aged, 80 and over , Holmium , Humans , Laser Therapy/adverse effects , Lasers, Solid-State/therapeutic use , Male , Middle Aged , Organ Size , Postoperative Complications , Prostate/pathology , Prostate-Specific Antigen/blood , Prostatic Hyperplasia/surgery , Quality of Life , Retrospective Studies , Seoul , Transurethral Resection of Prostate/methods , Treatment Outcome
19.
Article in English | WPRIM | ID: wpr-42192

ABSTRACT

PURPOSE: To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in relation to prostate size and urodynamic parameters, including bladder outlet obstruction index (BOOI), presence of detrusor overactivity, and detrusor contractility, and to investigate factors predictive of HoLEP success. METHODS: This retrospective analysis of prospective data included 174 consecutive patients treated with HoLEP at Samsung Medical Center from 2009 to 2013. Prostate-specific antigen, prostate size, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) were evaluated preoperatively, while prostate-specific antigen, uroflowmetry/postvoid residual (PVR) urine, and IPSS were measured six months after HoLEP. Two definitions of treatment success were established based on the following three variables: IPSS, maximum flow rate (Qmax), and QoL index. Factors predictive of HoLEP success were identified using multiple logistic regression analysis. RESULTS: IPSS/QoL, Qmax, and PVR improved significantly following HoLEP. Improvements in IPSS and PVR were more significant in the BOOI> or =40 group compared to the BOOI or =40 group had a significantly higher success rate, and BOOI> or =40 was a significant predictor of HoLEP success based on the multivariate analyses. CONCLUSIONS: We found good surgical outcomes after HoLEP, and specifically patients with a higher BOOI had a greater chance of surgical success.


Subject(s)
Holmium , Humans , Lasers, Solid-State , Logistic Models , Multivariate Analysis , Prospective Studies , Prostate , Prostate-Specific Antigen , Prostatic Hyperplasia , Retrospective Studies , Urinary Bladder Neck Obstruction , Urinary Bladder, Overactive , Urodynamics
20.
Article in English | WPRIM | ID: wpr-89591

ABSTRACT

PURPOSE: To investigate the factors associated with the occurrence of and recovery from transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: From March 2009 to December 2012, 391 consecutive patients treated with HoLEP for benign prostatic hyperplasia were enrolled. Information regarding age, prostate volume, International Prostate Symptom Score, Overactive Bladder Symptom Score, peak urinary flow rate, postvoid residual urine, and operation time was collected. TUI was defined as a patient complaint of urine leakage, regardless of type. Logistic regression was used to investigate the factors associated with the occurrence of TUI, and the Kaplan-Meier test was used to analyze the TUI recovery period. RESULTS: TUI after HoLEP occurred in 65 patients (16.6%), 52 patients of whom (80.0%) showed recovery within three months. Stress and urge urinary incontinence and postvoid dribbling occurred in 16 patients (4.1%), 29 patients (7.4%), and 33 patients (8.4%), respectively. Age (odds ratio [OR]=3.494; 95% confidence interval [CI]=1.565~7.803; p=0.002) and total operation time (OR=3.849; 95% CI=1.613~9.185; p=0.002) were factors that significantly affected the occurrence of TUI. CONCLUSIONS: TUI, defined as any type of urine leakage, occurred after HoLEP in some patients, most of whom recovered within three months. Stress urinary incontinence occurred in only 4% of patients after HoLEP. Age and total operation time were associated with the occurrence of postoperative TUI.


Subject(s)
Holmium , Humans , Kaplan-Meier Estimate , Lasers, Solid-State , Logistic Models , Prostate , Prostatic Hyperplasia , Risk Factors , Urinary Bladder, Overactive , Urinary Incontinence
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