scholarly journals Understanding holmium laser enucleation of the prostate (HoLEP) recovery: Assessing patient expectations and understanding

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mark A Assmus ◽  
Matthew S. Lee ◽  
Tim Large ◽  
Amy Krambeck
Keyword(s):  
Recovery Period ◽  
Primary Objective ◽  
Patient Communication ◽  
Holmium Laser ◽  
Clinical Registry ◽  
Patient Reported ◽  
Physician Patient Communication ◽  
Laser Enucleation ◽  
Physician Patient ◽  
Holmium Laser Enucleation

Introduction: Although holmium laser enucleation of the prostate (HoLEP) is a highly effective surgery, there is a variable recovery period where patients may experience hematuria, dysuria, or urinary incontinence (UI). Despite preoperative consultation, there is a paucity of literature examining the effectiveness of physician-patient communication in preparing the patient for the postoperative recovery period. We sought to examine recovery expectations as a patient-reported outcome (PRO) metric for HoLEP. Methods: With institutional review board approval, we queried our electronic medical record and retrospective clinical registry to identify 50 consecutive patients that underwent HoLEP from November 2019 to March 2020 by two endourologists. Patients were provided questionnaires via Twistle© ≥6 months postoperatively. Patient demographics and perioperative course was examined in the context of responses. Our primary objective was determining whether patients felt they had a reasonable understanding of the recovery process. Results: We observed a 92% (46/50) response rate, with an average patient age of 69.4 years (range 55–88). Overall, 91.3% (42/46) felt they had a reasonable understanding of the recovery. Additionally, 97.8% (45/46) were aware of temporary UI, with 87% having ≥1 episodes of UI after catheter removal. We found 47.8% (22/46) of patients expected UI to resolve within 30 days, while 8.6% expected >90 days of UI. All patients were aware of the risk of hematuria, with 93.5% (43/46) expecting resolution within 30 days (<7 days: 47.8%; 7–14 days: 28.3%; 15–30 days: 17.4%). Conclusions: Although surgical technique continues to improve HoLEP, ensuring adequate physician-patient communication to optimize expectations is crucial. We report patient understanding of HoLEP recovery and areas for future improvement.

scholarly journals Significance of Membranous Urethral Length for Recovery From Postoperative Urinary Incontinence Following Holmium Laser Enucleation of the Prostate

2020 ◽  
Vol 24 (4) ◽  
pp. 358-364
Author(s):  
Shintaro Oka ◽  
Keita Kobayashi ◽  
Kenji Matsuda ◽  
Kimio Takai
Keyword(s):  
Urinary Incontinence ◽  
Recovery Time ◽  
Spin Echo ◽  
Recovery Period ◽  
Holmium Laser ◽  
Fast Spin Echo ◽  
Rank Test ◽  
Early Recovery ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Purpose: The aim of this study was to determine the significance of the membranous urethral length (MUL), including the thickness of the urethral sphincter, for recovery from postoperative stress urinary incontinence (SUI) following holmium laser enucleation of the prostate (HoLEP).Methods: We analyzed 78 patients who underwent HoLEP between June 2013 and September 2018, all of whom preoperatively received magnetic resonance imaging. MUL was measured using sagittal T2-weighted fast spin-echo images. The clinical and anatomical factors associated with MUL were evaluated. The recovery time of urinary incontinence was compared between patients with a long MUL (≥14 mm) and a short MUL (<14 mm). SUI included both stress and mixed urinary incontinence. Continence was defined as complete dryness.Results: The median MUL in patients without incontinence at 1 month postoperatively was significantly longer than the MUL in patients with incontinence (15.3 mm vs. 12.7 mm, P<0.001). The continence rates at 1 month after HoLEP in patients with longer MULs and shorter MULs were 80.4% and 30.0%, respectively. The recovery time of urinary incontinence in patients with longer MULs (≥14 mm) was significantly shorter than that in patients with shorter MULs (<14 mm) (log-rank test, P=0.001). After 6 months, the continence rates in patients with longer MULs and shorter MULs were similar (97%). MUL was significantly correlated with the recovery period of urinary incontinence (r=-0.459, P<0.001).Conclusions: MUL was useful for predicting early recovery from urinary incontinence following HoLEP. This study provides evidence that postoperative urinary incontinence following a transurethral procedure for benign prostatic hyperplasia was associated with anatomical factors. A long MUL was associated with better tolerance to urinary sphincter damage by the transurethral procedure.

Patient-reported Sexual Outcomes After Holmium Laser Enucleation of the Prostate: A 3-year Follow-up Study

Urology ◽  
2014 ◽  
Vol 84 (2) ◽  
pp. 421-426 ◽  
Author(s):  
Dane E. Klett ◽  
Mark D. Tyson ◽  
Chinedu O. Mmeje ◽  
Rafael Nunez–Nateras ◽  
Yu-Hui Chang ◽  
...  
Keyword(s):  
Holmium Laser ◽  
Follow Up Study ◽  
Sexual Outcomes ◽  
Patient Reported ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

scholarly journals Aquablation versus holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia in medium-to-large-sized prostates (ATHLETE): protocol of a prospective randomised trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046973
Author(s):  
Gautier Müllhaupt ◽  
Sabine Güsewell ◽  
Hans-Peter Schmid ◽  
Valentin Zumstein ◽  
Patrick Betschart ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Prostatic Hyperplasia ◽  
Holmium Laser ◽  
Inpatient Setting ◽  
Patient Reported ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

IntroductionA novel method for the surgical treatment of benign prostatic hyperplasia (BPH) called Aquablation has become commercially available. Previous studies have been able to show similar functional results when compared with transurethral resection of the prostate and a high efficacy has been demonstrated when this approach is applied to patients with a prostate size of 80–150 cm3.Holmium laser enucleation of the prostate (HoLEP) is a well-established procedure in the surgical treatment of BPH in prostate glands larger than 30 mL and a first-line therapy in glands over 80 mL. To date, no data are available whether Aquablation is non-inferior compared with HoLEP in the treatment of patients with medium-to-large-sized prostates regarding safety and efficacy.Methods and analysisThis is a prospective, randomised, open-label, non-inferiority clinical trial conducted at a Swiss centre of tertiary care. The primary outcome is assessment of non-inferiority of Aquablation compared with HoLEP in reducing lower urinary tract symptoms due to benign prostatic obstruction measured by the International Prostate Symptom Score (IPSS). Randomisation will be performed using secuTrial, stratifying on age (<70 years, 70+ years) and prostate volume (<100 mL, 100+ mL). Both interventions are performed in an inpatient setting and regular follow-up controls starting 8 weeks after intervention and continuing up to 5 years will be performed. The primary outcome (change in IPSS from baseline to 6 months) will be tested for non-inferiority with a one-sided t-test. Secondary outcomes, such as efficacy parameters, several patient-reported outcome measures, and periprocedural and safety parameters will be described by calculating means or relative frequencies for each treatment group and testing differences with two-sided standard superiority tests.Ethics and disseminationThe study was approved by the local ethics committee (EKOS 2020-02353). Results of the primary endpoint and each of the secondary endpoints will be published in an international peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT04560907).

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