Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update

Nickel, J. Curtis; Aaron, Lorne; Barkin, Jack; Elterman, Dean; Nachabe, Mahmood; Zorn, Kevin C.

doi:10.5489/cuaj.5616

Cited by 78 publications

(86 citation statements)

References 89 publications

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“…These potential advantages of HoLEP have led some authors to suggest HoLEP as the new gold standard for the surgical management of BPH [3,10]. Morcellation of the prostate adenoma is currently the standard method after HoLEP procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Introduction of the Holmium laser represented a turning point in minimally invasive laser therapy for BPH, as it achieves size-independent prostatic cavity similar to simple open prostatectomy with significantly low-DOI: 10.1159/000499092 er perioperative morbidity [1]. The Holmium laser has rapidly gained a lot of acceptance supported by well-designed randomized controlled trials and meta-analyses [2][3][4].…”

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confidence: 99%

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The ex vivo and in vivo Characteristics of New DrillCut<sup>TM</sup> Prostate Morcellator after Holmium Laser Enucleation of the Prostate: A Pilot Study

et al. 2019

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Introduction: The DrillCut^TM morcellator is marketed for its fast and highly efficient removal of prostatic tissue and a higher level of patient safety. However, a paucity of publications has looked into its actual efficacy and safety. The aim of our study was to evaluate its ex vivo and in vivo efficiency and to compare its results with other devices presented in the literature. Patients and Methods: We conducted a prospective pilot study on patients who underwent holmium laser enucleation of the prostate (HoLEP) from 2017 to 2018 using the Top-Down technique. Enucleated adenomas were morcellated using the DrillCut^TM morcellator. We collected both preoperative and operative data. Operative data included the enucleated adenoma weight and operative time. Various morcellator parameters were collected including morcellation time and efficiency. We recorded the encountered complications and device malfunction. Ex vivo characteristics were evaluated in terms of morcellation speed and aspiration power. Results: Sixty consecutive patients with a median age of 72.8 years were included. The enucleated adenoma was retrieved in 12.5 min (4–58). The median resected prostatic weight was 90 g (44–242). The DrillCut^TM efficiency was calculated as 6.46 g/min (2.7–15). Only one patient had a simple bladder mucosal injury. Device malfunction was encountered in 4 patients (6.6%) due to blockage of the morcellator blades. The ex vivo aspiration speed was 52 s/L, while the morcellation power was 14 g/2 min. Conclusion: Our results showed that the DrillCut morcellator was effective and safe in managing our patients post-HoLEP. The DrillCut^TM has better ex vivo morcellation power but modest aspiration speed in comparison to other morcellators.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The ex vivo and in vivo Characteristics of New DrillCut<sup>TM</sup> Prostate Morcellator after Holmium Laser Enucleation of the Prostate: A Pilot Study

et al. 2019

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“…It is strongly recommended as a treatment option for moderate‐to‐severe LUTS with enlarged prostates >80 cc. But for this indication, guideline recommendations vary between open prostatectomy as a first‐line therapy, HoLEP as an equal first‐line option with open prostatectomy and HoLEP as a size‐independent procedure . So, the question arises as to which patients with which characteristics are best treated with HoLEP.…”

Section: Introductionmentioning

confidence: 99%

A matched‐pair analysis of patients with medium‐sized prostates (50 cc) treated for male LUTS with HoLEP or TURP

Magistro

Westhofen

Stief

et al. 2019

LUTS

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Objectives: To evaluate perioperative parameters, early functional outcomes, and the safety profile in a matched-pair analysis of lower urinary tract symptom (LUTS) patients treated with holmium laser enucleation of the prostate (HoLEP) or transurethral resection of the prostate (TURP). Methods:We conducted a retrospective, matched-pair analysis of 2011 men treated for LUTS in our institution from 2013 to 2017. In the final analysis, 197 patients (HoLEP n = 97; TURP n = 98) were matched for prostate size (50 cc), age, and body mass index, and both cohorts were compared for demographic parameters, clinical outcomes, and adverse events according to the Clavien-Dindo classification.Results: The perioperative assessment revealed a significantly higher tissue retrieval percentage of 75.4% (interquartile range [IQR] 64-81.2) after HoLEP in comparison to 47.3% (IQR 40-54.7) after TURP (P <.001). A shorter surgery time was reported for TURP with a median time of 55.5 minutes (IQR 48-70.5), whereas the median time for HoLEP was 62 minutes (IQR 51-85) (P =.006). The median improvements in International Prostate Symptom Score (IPSS) were 11 points (IQR 5.5-17) and 7 points (IQR 3-14) for HoLEP and TURP, respectively (P =.007). Peak urinary flow rate (Q max ) increased more after HoLEP (12.0 mL/s; IQR 7-23) than after TURP (8.5 mL/s; IQR 5-18.25) (P =.028). With an overall incidence of adverse events of 6% (n = 6) compared to 16% (n = 16%), significantly fewer complications occurred after HoLEP than after treatment with TURP (P <.05). Conclusions:HoLEP is not only an attractive alternative for the enucleation of larger prostates, but it must be considered a size-independent technique with the potential to outdo the current reference method TURP. K E Y W O R D S benign prostatic hyperplasia, holmium laser enucleation of the prostate (HoLEP), lower urinary tract symptoms, transurethral resection of the prostate (TURP)

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“…A urinalysis is mandatory, although every effort should be made to obtain a recent (<6 month) test to prevent needless visits to laboratories. 31 A thorough history, with use of validated questionnaires (International Prostate Symptom Score [IPSS]) to identify degree of bother should be done. 32 Documentation of any gross hematuria, ability to void, current medications, and lack of predominant irritative symptoms must be done to record why ancillary procedures (e.g., cystoscopy) are not needed.…”

Section: Virtual Visitmentioning

confidence: 99%

“…Caution should be applied when considering an antimuscarinic or beta-3 agonist for patients with storage symptoms with an inadequate response to alpha-blocker therapy without prior documentation of a low post-void residual. 31 With the current operative restrictions, if a man goes into AUR and requires catheterization, our preference would be to bring the patient in for clean intermittent catheter (CIC) teaching managing men's health during coVID-19…”

Section: Virtual Visitmentioning

confidence: 99%

Clinical pearls to managing men’s health conditions during the COVID-19 pandemic

Witherspoon

Fitzpatrick²,

Patel³

et al. 2020

CUAJ

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Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update

Cited by 78 publications

References 89 publications

The ex vivo and in vivo Characteristics of New DrillCut<sup>TM</sup> Prostate Morcellator after Holmium Laser Enucleation of the Prostate: A Pilot Study

The ex vivo and in vivo Characteristics of New DrillCut<sup>TM</sup> Prostate Morcellator after Holmium Laser Enucleation of the Prostate: A Pilot Study

A matched‐pair analysis of patients with medium‐sized prostates (50 cc) treated for male LUTS with HoLEP or TURP

Clinical pearls to managing men’s health conditions during the COVID-19 pandemic

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