scholarly journals Safety and Efficacy of a Modified Technique of Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia

2021 ◽  
Vol 11 (6) ◽  
pp. 2467
Author(s):  
Giovanni Cochetti ◽  
Michele Del Zingaro ◽  
Mattia Panciarola ◽  
Alessio Paladini ◽  
Paolo Guiggi ◽  
...  
Keyword(s):  
Laser Energy ◽  
External Sphincter ◽  
Holmium Laser ◽  
Comparable Efficacy ◽  
Low Grade ◽  
Modified Technique ◽  
Safety And Efficacy ◽  
Relevant Risk Factor ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Holmium laser enucleation of the prostate (HoLEP) is a valid alternative to transurethral resection of the prostate and open simple prostatectomy for the treatment of a larger prostate, demonstrating comparable efficacy and lower morbidity. One of the most bothersome symptoms after HoLEP is urinary incontinence (UI), which is present in almost 20% of patients, with a recovery rate of over 80% at 3 months. A relevant risk factor linked to UI is the damage of the external sphincter during the enucleation of adenoma tissue close to it. In our modified HoLEP technique named Cap HoLEP, we preserve the anterior prostate portion proximal to the external sphincter. This cap of adenoma could reduce mechanical stress and laser energy widespread on the sphincter, acting as a protective barrier. The aim of this study was to describe the Cap HoLEP technique and to evaluate its safety and efficacy by assessing peri-operative and functional outcomes. We enrolled all patients who consecutively underwent Cap HoLEP from December 2017 to October 2019 in our hospital. Baseline characteristics; the International Prostate Symptom Score; uroflow findings; intraoperative data, intraoperative, and postoperative complications; and UI were all assessed. The median operative time was 122 min with 138 kJ of laser energy delivered. Median ∆Hb was 0.8 gr/dL. Seven low-grade complications were recorded. At 1 month, 34.8% of patients presented UI, 16.7% urge incontinence, 13.6% stress incontinence, and 4.5% mixed incontinence. At 3 months, UI showed a significant improvement, decreasing to 12.1%. At 6 and 12 months, UI was 7.6% and 3%, respectively. Our modified HoLEP technique is safe and effective, allowing significant improvement in the postoperative UI rate.

scholarly journals Introduction of a New Score to Assess Surgical Efficiency in Holmium Laser Enucleation of the Prostate

2020 ◽  
Vol 104 (11-12) ◽  
pp. 914-922
Author(s):  
Bernd Rosenhammer ◽  
Maximilian Schönhärl ◽  
Roman Mayr ◽  
Marco J. Schnabel ◽  
Maximilian Burger ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Control ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Laser Energy ◽  
Learning Curves ◽  
Holmium Laser ◽  
Surgical Experience ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

<b><i>Introduction:</i></b> While holmium laser enucleation of the prostate (HoLEP) is accepted as safe and efficient, a long learning curve is considered the main reason for its slow adoption in clinical practice. So far, no standardized and easy-to-use parameter has been implemented to measure surgical experience or efficiency which could be useful for training and quality control purposes. The aim of the present study was to evaluate the learning curves of 2 HoLEP beginners and to identify applicable efficiency outcome measures as well as potentially complicating factors in performing HoLEP. <b><i>Patients and Methods:</i></b> A total of 594 patients treated by HoLEP between September 2016 and May 2019 were enrolled. The procedures were initially performed by 1 HoLEP expert (reference surgeon); over time, 2 further surgeons were trained. Baseline characteristics, enucleation weight, morcellation and enucleation time, laser energy usage, and postoperative results were recorded prospectively. The learning curves of the 2 novices were analyzed and compared to the reference surgeon. Logistic regression analyses were performed to identify predictors for postoperative grade ≥2 complications. <b><i>Results:</i></b> Median enucleation ratio and complication rates did not significantly alter along the learning curves. Median enucleation speed and laser energy application of the 2 novices significantly improved with growing experience. Combining these variables, we introduced the “HoLEP efficiency score” (HES) which demonstrated the most appropriate value to reflect the surgical experience and efficiency. The median HES for the reference surgeon was 82.8 min kJ/g. For the 2 novices, a drop from 130 and 124.4 min kJ/g by −57 and −30%, respectively, was observed. Among several tested clinical parameters, the presence of prostate cancer (<i>p</i> = 0.047) and the surgical caseload (<i>p</i> &#x3c; 0.001) influenced the HES. On multivariable logistic regression, American Society of Anesthesiologists score and prostate cancer were independent predictors for grade ≥2 complications (<i>p</i> = 0.002, odds ratio [OR] 2.042 and <i>p</i> = 0.038, OR 1.940). <b><i>Conclusion:</i></b> We introduce the HES as an objective and measurable tool to quantify surgical efficiency. In clinical practice, the HES may find application in training and quality control purposes as well as in comparing surgical modifications and hardware. Patients with prostate cancer seem to be more challenging cases and have a higher risk for complications, and may preferably be treated by experienced surgeons.

scholarly journals Holmium Laser Enucleation of the Prostate: Modified Two-Lobe Technique versus Traditional Three-Lobe Technique—A Randomized Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Congcong Xu ◽  
Zhen Xu ◽  
Caixiu Lin ◽  
Sheng Feng ◽  
Mingwei Sun ◽  
...  
Keyword(s):  
Quality Of Life ◽  
International Prostate Symptom Score ◽  
Randomized Study ◽  
Prostatic Hyperplasia ◽  
Holmium Laser ◽  
Safety And Efficacy ◽  
Laser Enucleation ◽  
Secondary Outcomes ◽  
Holmium Laser Enucleation

Background. Holmium laser enucleation of the prostate (HoLEP) is considered the standard endoscopic treatment of benign prostatic hyperplasia (BPH), but traditional HoLEP surgery will cause some postoperative complications. This study was attempted to evaluate the safety and efficacy of modified two-lobe technique versus traditional three-lobe technique of HoLEP focusing mainly on incidences of retrograde ejaculation (RE) and urinary incontinence (UI). Methods. From March 2014 to February 2017, 191 men with BPH were randomly assigned to two groups: 97 underwent modified two-lobe technique; 94 underwent traditional three-lobe technique. All patients were followed up for 12 months. Primary outcomes were incidences of RE and UI, and secondary outcomes were international prostate symptom score (IPSS), quality of life (QOL), maximal urine flowing rate (MFR), and residual urine among the studied patients. Results. Compared with the traditional technique, patients in the modified group had a statistically significant decrease in frequency of UI (1.03% vs 8.51%, p=0.036) and RE in the 6th month (33.33% vs 63.64%, p=0.030) and 12th month (13.33% vs 50%, p=0.034) and a significant increase in ejaculatory volume in the 6th month (p=0.050) and 12th month (p=0.003). Besides, the modified HoLEP was more beneficial to patients according to the change of QoL score at 1 month (p=0.002), 3 months (p=0.004), 6 months (p=0.026), and 12 months (p=0.015). Conclusions. The modified two-lobe technology of HoLEP reduced the incidence of RE and UI, which improved the quality of life of the patients after surgery compared to the traditional three-lobe technology. This trial is registered with ChiCTR1800018553.

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