Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks.

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) allows to treat extremely large prostates (>200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes. METHODS: Four hundred and fifty-nine patients were divided into three groups: group 1 included 278 patients (<100 cm3); group 2 included 169 patients (100-200 cm3); group 3 included 12 patients (>200 cm3). RESULTS: The duration of enucleation in group 1 was 56.5 ± 10.7 min; in group 2 was 96.4 ± 24.9 min; in group 3 was 120.9 ± 35 min. The duration of morcellation in group 1 was 37.5 ± 7.3 min; in group 2 was 63.3 ± 11.2 min; in group 3 was 84.0 ± 25.6 min. The enucleation efficiency in group 3 (1.70 g/min) was higher (p<0.05) than in group 1 (1.05 g/min) and group 2 (1.23 g/min). Morcelation efficiency was lower in groups 1 and 2 (1.58 and 1.87 g/min, respectively) than in group 3 (2.45 g/min) (p<0.05).Follow-up period lasted 18 months. There were no significant differences (p>0.05) in International Prostate Symptom Score, Qmax, quality of life and postvoid residual volume for 1, 3, 6, 12 and 18 months after surgery. CONCLUSIONS: HoLEP is a safe, highly efficacious and a size-independent procedure.

Percutaneous US-guided renal cryoablation using 3D modeling.

INTRODUCTION: The article describes the first experience of performing percutaneous ultrasound (US)-guided cryoablation of renal tumor and assesses the safety and short-term results of treatment. MATERIALS AND METHODS: Twelve patients were subjected to US-guided cryoablation of renal tumor in 2015. The tumor size in 11 patients was up to 3.0 cm (T1а); in one female patient, 4.5 cm (T1b). Tumors were assessed according to the PADUA score. In eight patients, it was 6-7 (low); in three patients, 8-9 (average); in one, 10 (high). All the patients underwent US examination using a FlexFocus 800 apparatus with convex abdominal transducers. Before surgery and 6 months later, all the patients underwent renal Doppler US and contrast-enhanced computed tomography. RESULTS: The average cryoablation time was 60 min. Seven operations were performed under spinal anesthesia and five operations under local anesthesia. The follow-up period lasted 8 months on average. According to the ultrasonography and Doppler findings, after 6 months, the tumor (T1a) in 11 patients reduced in size by an average of 7-8 mm and had no blood supply.T1b patient's mass size reduces from 4.5 to 3.7 cm; however, a 1.5 cm area with a high attenuation gradient of the contrast medium was visualized. Later, the patient was subjected to laparoscopic renal resection. Histological finding revealed clear-cell carcinoma. CONCLUSIONS: We consider percutaneous US-guided cryoablation as a method of choice for patients with stage T1a renal tumor localized on the posterior or lateral surface in the inferior or middle segment without sinus involvement and PADUA <9.