Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.

Primary prostate Burkitt's lymphoma resected with holmium laser enucleation of the prostate:A rare case report

BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.

Study on the Treatment of Benign Prostate Hyperplasia Combined with Underactive Bladder Detrusor Contraction by Transurethral Plasma Enucleation of the Prostate

Objective: Exploring the clinical efficacy of transurethral plasma enucleation of the prostate in the treatment of benign prostatic hyperplasia with underactive bladder detrusor contractility. Methods: Retrospective analysis of the clinical data of 68 patients with benign prostatic hyperplasia and underactive detrusor muscle contractility treated by our department from July 2021 to July 2022. The above patients all met the diagnosis of benign prostatic hyperplasia, excluding prostate cancer and urethral stricture. Urodynamics showed a decrease in the contractile force of the bladder detrusor muscle, and the surgical equipment used Olympus bipolar plasma resection equipment method. Divide the above patients into two groups: the experimental group of 34 patients who underwent transurethral plasma enucleation of the prostate and the control group of 34 patients who underwent transurethral plasma resection of the prostate. Evaluate the preoperative clinical baseline level and postoperative observation indicators of the two groups of patients, and compare the statistical differences between the two groups. Results: Both groups of patients successfully completed the surgery, and there were no serious complications such as rectal or bladder perforation during the surgery, with less bleeding. The postoperative QOL, IPSS, Qmax, and residual urine volume of patients undergoing transurethral plasma enucleation and resection of the prostate were significantly improved compared to those before surgery (P 0.05). Conclusion: Transurethral enucleation of the prostate has good efficacy and safety in the treatment of benign prostatic hyperplasia combined with weakened detrusor muscle contractility. Compared with traditional electric resection surgery, the efficacy is more significant. In terms of the main complications of the surgery, although there are slightly more patients with temporary urinary incontinence after prostate enucleation, there is no statistically significant difference compared to after electric resection, and they can recover to normal in the short term.

Innovative endoscopic enucleations of the prostate--Xie’s Prostate Enucleations

In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

Bipolar transurethral enucleation and resection of the prostate:Whether it is ready to supersede TURP?

Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia(BPH).However,its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique.We reported the patient outcomes with our technique.Methods:We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate(B-TUERP)between March 2015 and September 2015.Pre-and perioperative parameters were obtained from medical charts.Postoperative follow-ups were administrated at 1,3,6,12 and 24 month(s)after surgery,respectively.Results:All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%.Qmax was significantly improved immediately after surgery,followed by a continuous improvement throughout the follow-ups.Following a steep decrease in mean prostate specific antigen(PSA)and post void residual(PVR)observed within the first half year after surgery,the serum PSA was then maintained at a constant level of 0.61 ng/mL.Temporary urinary retention was found in four cases(7.7%).Stress urinary incontinence occurred in five patients(9.6%),with the condition resolved in 1e2 weeks without extra treatment.Urethral strictures and bladder neck contractures,as the most commonly observed long-term complications,developed in four patients(7.7%).No recurrence was found during 2 years of follow-ups.An improvement in International Index of Erectile Function(IIEF-5)scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery,and sustained throughout the 24-month period.Conclusions:Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice.Currently,bipolar resection is a commonly employed procedure in clinical settings,and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists.Based on these findings,we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.

Esophagogastric junction gastrointestinal stromal tumor:Resection vs enucleation

Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly controversial.Many different options are nowadays at our disposal.From surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as unresectable.The EGJ GISTs represent a stimulating challenge for the surgeon.The anatomical location increases the possibility of postoperative complications.As the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?

Enucleation and evisceration: indications, complications and clinicopathological correlations

·AIM: To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.·METHODS: A total of 107 subjects who underwent enucleation and/or evisceration and received hydroxyapatite implants(Scleral wrap or mesh) were assessed. For each patient clinicopathological data was collected which included demographic information,clinical history, primary clinical diagnosis, main cause of ophthalmic surgery(traumatic, non-traumatic), type of surgical procedure(enucleation, evisceration) and pathological report. Patients’ postoperative clinical visits were checked for procedure-related complications during first year after surgery.·RESULTS: One hundred and seven patients(male:65.4%; mean age: 26y) underwent enucleation(n=100) or evisceration(n =7) due to traumatic(n =41) and non-traumatic(n =66) causes. Disfiguring painful blind eye was the most common indication of surgery(66.4%),followed by leukocoria(19.6%) and endophthalmitis(4.7%). The main types of injury included firecracker,traffic and work accidents, and sharp object perforating injury. In 53(80.3%) subjects in non-traumatic group the initial clinical diagnosis matched the histopathologicalresults. Malignant tumors(retinoblastoma: 47.5%,malignant melanoma: 27.3%) were the most common pathological diagnoses followed by phthisis bulbi(25.8%).The most common procedure-related complications were major eye discharge(39.6%), and implant exposure and discharge(20.8%).·CONCLUSION: Trauma and malignant tumors are the leading causes of enucleation-evisceration. Despite developing new techniques and materials, enucleation is still associated with considerable postoperative complications.

Symptomatic subserosal gastric lipoma successfully treated with enucleation

Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

Enucleation for gastrointestinal stromal tumors at the esophagogastric junction:Is this an adequate solution?

The authors discussed the proposal by Coccolini and colleagues to treat gastrointestinal stromal tumors (GISTs) at the esophagogastric junction with enucleation and,if indicated,adjuvant therapy,reducing the risks related to esophageal and gastroesophageal resection.They concluded that,because the prognostic impact of a T1 high-mitotic rate on esophageal GIST is worse than that of a T1 high-mitotic rate on gastric GIST,enucleation may not be an adequate surgery for esophagogastric GISTs with a high mitotic rate in which the guarantee of negative resection margins and adjuvant therapies can be the only chance of survival.

Prospects and applications of enucleation in solid pseudopapillary neoplasms of the pancreas

Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.

Long-term survival after enucleation of a giant esophagea gastrointestinal stromal tumor

Gastrointestinal stromal tumors(GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Less than 1% occurs in the esophagus. Surgery is the primary treatment for patients with GISTs. We report a29-year-old male was admitted after the detection of a posterior mediastinal mass during work-up with routine examination. He did not have any disease-related symptoms. The physical examination was unremarkable. Chest computed tomographic scan, the barium esophagogram and endoscopic esophageal ultrasound showed benign neoplasm. The patient was performed an enucleation surgery through the right posterolateral thoracotomy. The pathology revealed a 13.0 cm × 12.0cm × 5.0 cm mass. The tumor was CD117(C-kit), PDGFRA and DOG1 positive. These findings were consistent with a GIST of the esophagus. So the diagnosis of GIST of esophagus was confirmed. The pathological diagnosis of low grade of GIST of esophagus was confirmed. The patient has no evidence of recurrence and is in good clinical conditions up-to date, five years after surgery.

Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts

BACKGROUND The odontogenic jaw cyst is a cavity containing liquid,semifluid or gaseous components,with the development of the disease.In recent years,with the rapid development of oral materials and the transformation of treatment of jaw cysts,more options are available for treatment of postoperative bone defect of jaw cysts.Guided bone regeneration(GBR)places biomaterials in the bone defect,and then uses biofilm to separate the proliferative soft tissue and the slow-growing bone tissue to maintain the space for bone regeneration,which is widely used in the field of implantology.AIM To observe the clinical effect of GBR in repairing bone defect after enucleation of small and medium-sized odontogenic jaw cysts.METHODS From June 2018 to September 2020,13 patients(7 male,6 female)with odontogenic jaw cysts were treated in the Department of Oral Surgery,Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.Adults without hypertension,heart disease,diabetes or other systemic diseases were selected.The diagnosis was based on the final pathological results:11 cases were diagnosed as apical cysts,one as primordial cyst,and one as dentigerous cyst.The lesions were located in the maxilla in seven cases,and in the mandible in six cases.All cases were treated with the same method of enucleation combined with GBR.RESULTS Three to four months after the operation,the boundary between the implant site and the surrounding normal stroma was not obvious in patients with small-sized odontogenic jaw cysts.The patients with tooth defects were treated with implant after 6 mo.For the patients with medium-sized odontogenic jaw cysts,the density of the center of the implant area was close to the normal mass at 6 mo after surgery,and there was a clear boundary between the periphery of the implant area and the normal mass.The boundary between the periphery of the implant area and the normal mass was blurred at 8-9 mo after surgery.Patients with tooth defects were treated with implants at>6 mo after the operation.CONCLUSION Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts can shorten the time of osteogenesis,increase the amount of new bone formation,reduce complications,and improve quality of life.

A method for mouse oocyte enucleation assisted with zona pellucida dilating

Objective: To study the reliability of a new enucleation method, zona pellucida Dilating (ZPD) assisted enucleation method, for mouse oocyte enucleation.Methods: In ZPD enucleation method, the zona pellucida was dilating with the help of outside pression in enucleation needle after breakthrough by needle tip and the nucleus was aspirated by the needle entering the perivitelline space for enucleation. This method was employed and was compared with three other methods in this experiment. The efficiency of enucleation of mouse oocyte was examed.Result: ZPD assisted enucleation method is better than three others at the survival rate after enucleation and the simplicity of micromanipulation. The rate of forming pronucleus of reconstructed embryo from enucleated oocyte by ZPD methods is as high as 62.8 % and the reconstructed embryo at 4-cell stage was obtained.Conclusion: ZPD assisted method is a highly efficient and simple enucleation method with the advantage of saving manipulating time and it does less damage to the oocyte.

Effects of Different Enucleation Methods on Developmental Potency of Pig Handmade Clone Reconstructed Embryos

Effects of different enucleation methods on developmental potency of pig handmade clone（HMC）reconstructed embryo was investigated in the paper.We compared enucleation efficiency of blind cut method,first polar body（Pb1）positioning method and demecolcine（DM）assisted enucleation,as well as their effects on development of HMC reconstructed embryos.The results showed that overall enucleation efficiency of Pb1 positioning method was significantly higher than that of blind cut method（P〈0.05）.The protuberance rate and overall enucleation efficiency of 0.4μg/mL DM treated group for 60 min was significantly higher than that of other concentrations and time treatment groups（P〈0.05）.For effects on development of HMC reconstructed embryos,there was no significant difference between DM-assisted enucleation and Pb1 positioning method.In conclusion,appropriate addition of DM could enhance enucleation efficiency of HMC,which had no significant influence on developmental potency of reconstructed embryos.

Transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia ( BPH) . Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm la-

Initial experience of transurethral enucleation of submucosal bladder leiomyoma

Objective To evaluate the clinical effecacy and safety of transurethral of submucosal bladder leiomyoma. Methods Analyze retrospectively the clinical data of 6 patients ( 2 male,4 female) of submucosal bladder leio-

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques:a multicenter,real-world experience of 5068 patients

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

The learning curve for transurethral enucleation with bipolar energy for benign prostate hyperplasia:a single-surgeon experience of 494 patients

This study was performed to investigate the learning curve of transurethral enucleation with bipolar energy(TUEB)for benignprostatic hyperplasia.The study involved 494 consecutive patients who underwent TUEB for benign prostatic hyperplasia fromAugust 2018 to March 2022 by one surgeon(SJJ,Seoul National University Bundang Hospital,Seongnam,Korea).The patientswere followed up at 1 week,1 month,3 months,and 6 months postoperatively.To evaluate the learning curve of TUEB,perioperativeparameters including the enucleation ratio(enucleated tissue weight/transitional zone volume),TUEB efficiency(enucleatedtissue weight/operation time),and enucleation efficiency(enucleated tissue weight/enucleation time)were analyzed.Functionaloutcomes and postoperative complications were also assessed,including the International Prostate Symptom Score(IPSS),IPSSquality-of-life(QoL)score,and uroflowmetry outcomes.The patients’median age was 72(interquartile range[IQR]:66–78)years,and the estimated prostate volume and transitional zone volume were 63.0(IQR:46.0–90.6)ml and 37.1(IQR:24.0–60.0)ml,respectively.The enucleation ratio,TUEB efficiency,and enucleation efficiency were 0.60(IQR:0.46–0.54)g ml−1,0.33(IQR:0.22–0.46)g min−1,and 0.50(IQR:0.35–0.72)g min−1,respectively,plateauing after 70 cases.The functional outcomes,including total IPSS,IPSS QoL score,and uroflowmetry outcomes,significantly improved at 6 months after TUEB(all P<0.05),but without significant differences over the learning curve.Sixty-five(13.2%)patients developed complications after TUEB,21.5%of whom experienced major complications(Clavien–Dindo grade≥3).The rate of major complications declined as the number ofTUEB cases increased(P=0.013).Our results suggest that the efficiency of TUEB stabilized within 70 procedures.

Pancreatic enucleation:a valid surgical option with encouraging quality of life

In their study“Pancreatic Enucleation Patients Share the Same Quality of Life as the General Population at Long-Term Follow-Up”,Giuliani et al.(1)assess short-and long-term outcomes including quality of life after pancreatic enucleation(PE).PE aims to preserve endocrine and exocrine function while ensuring surgical ablation of a presumed benign pancreatic tumor(neuroendocrine tumors,mucinous cystadenoma,serous cystadenoma,branch duct intraductal papillary mucinous neoplasms and solid pseudopapillary tumors).