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 rar...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.展开更多
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 experi...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.展开更多
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 t...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-展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
Purpose: Few studies have analyzed cost differences between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), and none as regards resident training. We compared thes...Purpose: Few studies have analyzed cost differences between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), and none as regards resident training. We compared these costs at a teaching institution with residents from two Boston programs. Methods: We reviewed all patients who underwent TURP (January 2007-August 2010) or HoLEP (April 2008-August 2010) with residents, excluding those with prostate cancer, simultaneous procedures at the same time, or prior urethral procedures. Operative approach was determined following consultation between the senior resident and the attending surgeon. Operative, postoperative, and urologic follow-up costs were captured and analyzed from day of surgery to 6 months post-operatively. Costs were calculated by the Department of Decision Support Services. Results: 38 HoLEP and 23 TURP patients met inclusion criteria. The two groups were comparable with the exception of higher ASA score and anticoagulation use in the HoLEP group. Despite a decreased hospital stay (0.42 vs. 1.25 days), total costs for HoLEP were higher than TURP ($8380.00 vs. $5861.78 p < 0.05) due to higher operative times (123 min vs. 74 min, p < 0.05), resulting in higher operative costs ($6768.14 vs. $3853.35, p < 0.05). Conclusions: HoLEP costs are higher than TURP from longer operative times and higher intraoperative costs, partly due to resident teaching. However, senior residents more often selected HoLEP for medically complex and/or anticoagulated patients. Despite resident inexperience with HoLEP, the complication rate remained low. Higher costs must be weighed against HoLEP benefits, which include less morbidity, shorter hospital stays and faster recovery times.展开更多
基金Supported by the Kunshan Research and Development Project,No.KSZ2203the Kunshan Research and Development Project,No.KZYY2205.
文摘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.
文摘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.
文摘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-
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
文摘Purpose: Few studies have analyzed cost differences between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), and none as regards resident training. We compared these costs at a teaching institution with residents from two Boston programs. Methods: We reviewed all patients who underwent TURP (January 2007-August 2010) or HoLEP (April 2008-August 2010) with residents, excluding those with prostate cancer, simultaneous procedures at the same time, or prior urethral procedures. Operative approach was determined following consultation between the senior resident and the attending surgeon. Operative, postoperative, and urologic follow-up costs were captured and analyzed from day of surgery to 6 months post-operatively. Costs were calculated by the Department of Decision Support Services. Results: 38 HoLEP and 23 TURP patients met inclusion criteria. The two groups were comparable with the exception of higher ASA score and anticoagulation use in the HoLEP group. Despite a decreased hospital stay (0.42 vs. 1.25 days), total costs for HoLEP were higher than TURP ($8380.00 vs. $5861.78 p < 0.05) due to higher operative times (123 min vs. 74 min, p < 0.05), resulting in higher operative costs ($6768.14 vs. $3853.35, p < 0.05). Conclusions: HoLEP costs are higher than TURP from longer operative times and higher intraoperative costs, partly due to resident teaching. However, senior residents more often selected HoLEP for medically complex and/or anticoagulated patients. Despite resident inexperience with HoLEP, the complication rate remained low. Higher costs must be weighed against HoLEP benefits, which include less morbidity, shorter hospital stays and faster recovery times.
