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.

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.

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.

Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia

Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.

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.

Can the lower urinary tract storage symptoms be completely resolved after plasmakinetic enucleation of the prostate？

The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction （BPO） could be completely resolved after plasmakinetic enucleation of the prostate （PKEP） and the possible predictors of persistent symptoms. Two hundred and sixty-seven cases of BPO performed PKEP from July 2008 to June 2009 were retrospectively analyzed. Five-year postoperative data were collected and compared with the preoperative data. According to the urodynamic results, the patients were divided into involuntary detrusor contraction （IDC） group （n = 95） and no IDC group （n = 172） preoperatively; the patients with IDC were divided into IDC-persistent group （n = 33） and IDC-resolved group （n = 62） after PKER The predictors of persistent IDC were analyzed. Compared with the preoperative data, the 5-year postoperative data showed that the IDC rate was lower （P --- 0.000）, Overactive Bladder Symptom Score （OABSS） was lower （P = 0.000）, maximum cystometric capacity （MCC） was larger （P= 0.000）, Prostate volume （PV） was smaller （P= 0.000）, and prostate-specific antigen （PSA） was lower （P= 0.000）. Compared with the no IDC group, the IDC group showed that the age was older （P = 0.016）, MCC was smaller （P = 0.004）, PSA was higher （P = 0.016）, and Chronic Inflammation rate was higher （P = 0.004）. Compared with IDC-resolved group after PKER IDC-persistent group showed that the age was older （P = 0.019）, MCC was smaller （P = 0.000）, PSA was higher （P = 0.013）, and Chronic Ihflammation rate was higher （P = 0.032）. The present study shows that the storage symptoms are still needed to be focused on after PKER The advanced patient age, MCC, PSA, and chronic inflammation may be the important clinical predictors of persistent IDC.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. Materials and Methods: During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. Results: TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. Conclusion: TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.