Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve

Shigemura, Katsumi; Tanaka, Kazushi; Yamamichi, Fukashi; Chiba, Koji; Fujisawa, Masato

doi:10.5213/inj.1630396.198

Cited by 39 publications

(22 citation statements)

References 23 publications

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“…HoLEP appears more suitable for larger prostate sizes, such as those > 100 mL, compared to conventional transurethral resection of the prostate [2]. Many researchers and surgeons have reported better voiding and storage symptom outcomes [5]. However, use of HoLEP has not yet spread as rapidly as expected when it was established in 1998, probably because HoLEP requires specific techniques of enucleation and morcellation in addition to conventional transurethral resection procedure.…”

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

et al. 2019

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KeywordsHoLEP · YAG laser · 5α-reductase inhibitor dosing · Surgery-related complications Abstract Purpose: The aim of this study was to compare and investigate the efficacy of using the 5α-reductase inhibitor dutasteride after holmium laser enucleation of the prostate (HoLEP) to improve postoperative urination and surgeryrelated complications. Methods: This is a retrospective observational study comparing patients who received or did not receive 5α-reductase inhibitors prior to HoLEP. Of a total of 270 patients, 40 received the 5α-reductase inhibitor dutasteride. We compared the factors including age, postoperative maximal flow rate (MFR; mL/s), postoperative prostate-specific antigen (PSA) (ng/mL), preoperative MFR (mL/s), preoperative PSA (ng/mL), prostate cancer (%), operative time (min), preoperative residual urine (mL), postoperative residual urine (mL), urinary incontinence (day 1; %), urinary incontinence (1 month; %), urinary incontinence (3 months; %), urethral catheter indwelling period (days), morcellation time (min), enucleation time (min), intraoperative complications (%), postoperative complications (%), pros-tate volume (mL), enucleated weight (g), and hospitalization period (days). Results: Postoperative PSA (p = 0.0071), morcellation time (p = 0.0444), postoperative complications (p = 0.0350) and prostate volume (p = 0.0069), but not enucleated prostate weight (p = 0.8809), were significantly lower in the dutasteride group. Importantly, enucleation efficiency and morcellation efficiency did not show any significant difference between the dutasteride and the nondutasteride groups. Conclusions: Use of a preoperative 5α-reductase inhibitor significantly correlated with surgeryrelated factors, with less morcellation time, fewer postoperative complications, and lower postoperative PSA. Surgeons performing HoLEP may wish to take these findings into account.

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Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

et al. 2019

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“…The factors involved in urinary incontinence were transition zone prostate volume and the enucleation ratio. Shigemura et al [27] also analyzed the result of 203 HoLEP operations. According to their report, postoperative SUI was present at 1, 3, and 6 months in 35 (29.4%), 20 (16.8%), and 6 patients (5.04%), respectively, who underwent surgery performed by beginner surgeons, and in 32 (38.1%), 11 (13.1%), and 4 patients (4.76%), respectively, who were treated by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Robotic Simple Prostatectomy: Why and How?

2020

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Increasingly many studies have presented robotic simple prostatectomy (RSP) as a surgical treatment option for large benign prostatic hyperplasia (BPH) weighing 80–100 g or more. In this review, some frequently used RSP techniques are described, along with an analysis of the literature on the efficacy and complications of RSP and differences in treatment results compared with other surgical methods. RSP has the advantage of a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RSP, and RSP facilitates the simultaneous treatment of important comorbid diseases such as bladder stones and bladder diverticula. In conclusion, RSP can be recommended as a safe and effective minimally invasive treatment for large BPH.

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“…Our published study of predictive factors for postoperative UI during the surgeon's learning curve especially found that preoperative detrusor overactivity and preoperative International Prostate Symptom Score (inverse correlation), patient age, and surgical mentorship (inverse correlation) were significant predictive factors for UI at 1 month after HoLEP with beginner surgeons, whereas first desire to void at 1 month after HoLEP was a significant predictor for UI in experienced surgeons by multivariate analysis. These data can contribute to surgical education for the prevention of AEs, such as UI, but multi‐institutional studies are required …”

Section: Post‐holep Uimentioning

confidence: 99%

“…These data can contribute to surgical education for the prevention of AEs, such as UI, but multi-institutional studies are required. 64,65…”

Section: Holep Versus Open Prostatectomymentioning

confidence: 99%

Current status of holmium laser enucleation of the prostate

Shigemura

Fujisawa

2017

Int J of Urology

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There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan. The present review introduces the current status of holmium laser enucleation of the prostate, so that it surely contributes to the knowledge of International Journal of Urology readers who could be experienced surgeons or beginners as well.

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Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve

Cited by 39 publications

References 23 publications

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

Robotic Simple Prostatectomy: Why and How?

Current status of holmium laser enucleation of the prostate

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