Objectives:To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.Methods:Transurethral resection and...Objectives:To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.Methods:Transurethral resection and vaporization of the prostate was performed in 55 male patients(260 specimens in total).In a standardized procedure,a bipolar resection loop was used for resection,and a bipolar button electrode was used for vaporization.Both electrodes were applied in each patient,either in the left or in the right lateral lobe.The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy.Results:The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm.The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm.The mean difference of necrosis zone depths between the two types of electrodes(PlasmaButtoneresection loop)was 0.0018 mm(p=0.691).Conclusion:For the first time,we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia.The measured values were lower than in all other transurethral procedures.Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.展开更多
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 benig...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.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
Background Transurethral resection of prostate （TURP） has been considered as the standard treatment for benign prostatic hyperplasia （BPH）. However, issues that have not yet been overcome for TURP include bleeding...Background Transurethral resection of prostate （TURP） has been considered as the standard treatment for benign prostatic hyperplasia （BPH）. However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate （BPVP） with ＂button-type＂ electrode against standard TURP for BPH.展开更多
文摘Objectives:To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.Methods:Transurethral resection and vaporization of the prostate was performed in 55 male patients(260 specimens in total).In a standardized procedure,a bipolar resection loop was used for resection,and a bipolar button electrode was used for vaporization.Both electrodes were applied in each patient,either in the left or in the right lateral lobe.The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy.Results:The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm.The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm.The mean difference of necrosis zone depths between the two types of electrodes(PlasmaButtoneresection loop)was 0.0018 mm(p=0.691).Conclusion:For the first time,we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia.The measured values were lower than in all other transurethral procedures.Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.
文摘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.
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Background Transurethral resection of prostate （TURP） has been considered as the standard treatment for benign prostatic hyperplasia （BPH）. However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate （BPVP） with ＂button-type＂ electrode against standard TURP for BPH.
