Holmium Laser Enucleation of the Prostate: Modified Technical Aspects

Baazeem, Abdulaziz; Elmansy, Hazem; Elhilali, Mostafa

doi:10.1111/j.1464-410x.2009.09111.x

Cited by 48 publications

(25 citation statements)

References 14 publications

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“…Many competing techniques using different energy sources (electric and different lasers) to accomplish the enucleation procedure have been reported. [2][3][4][5] However, retrieval of the adenoma after transurethral enucleation remains poorly evaluated. Transurethral resection of partially detached adenoma is not advantageous as it can induce more risk of bleeding, impaired visibility and is time consuming, especially for large prostates where the transurethral enucleation is superior to other minimally invasive surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…The enucleation phase of HoLEP was performed as previously described. 2 Retrieval of the prostate adenoma was performed by transurethral morcellation using either Piranha morcellator (Fig. 1, parts A and C) or the VersaCut (Fig.…”

Section: Interventionmentioning

confidence: 99%

“…In these patients, transurethral enucleation is superior to other techniques. 1 Different kinds of energy have been used in the enucleation procedure, including holmium YAG, 2 thulium, 3 Greenlight laser (532 nm), 4 and plasma kinetic energy, 5 ending by completely or partially detaching the intravesical adenoma. However, the techniques of prostate tissue retrieval, particularly intravesical morcellation of prostatic adenoma, are poorly evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Elshal

Mekkawy

Laymon

et al. 2015

CUAJ

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Introduction: We assess different approaches to retrieve the enucleated adenoma after transurethral enucleation of the prostate, particularly using the holmium laser. Methods: A retrospective review through our prospectively maintained database was performed looking for safety and efficacy of two morcellators. The enucleation phase of the holmium laser enucleation of the prostate (HoLEP) was classically performed followed by retrieval of the intravesical adenoma using either the Piranha (Wolf Inc., Knittlingen, Germany) or VersaCut (Lumenis) morcellator. A PubMed-MEDLINE search was conducted for all transurethral enucleation procedures and relevant data regarding methods of prostate tissue retrieval were extracted. Results: Strictly limiting the study to 3 reusable blades with each morcellator, we performed 67 and 55 consecutive procedures with Piranha and VersaCut, respectively. There was no significant difference between the two morcellators regarding perioperative complications, apart from 5 bladder mucosal injuries with the VersaCut (9%). Furthermore, there were similar retrieved tissue weight, mechanical problems-rate, catheter-time and hospital-stay in both morcellators. However, the Piranha morcellator needed significantly less morcellation-time, needed to use cold loop to remove non-morcellated pieces and to score the adenoma by laser for better bite of the adenoma, and had a higher median morcellation-rate 6.2 (rate: 2.8-12) g/min. Despite little reporting on morcellation, we had data on the tissue retrieval rate (2.6 to 6.5 g/min with Piranha and 1.9 to 11 g/min with VersaCut. Furthermore, bladder mucosal injury was reported in 1.4% and 0.7 to 5.7% with Piranha and VersaCut, respectively; bladder perforation with VersaCut was experienced in about 0.1 to 1.5% of patients. Our study is limited by its non-randomization. Conclusion: The Piranha morcellator was the most efficient and safe way to retrieve tissue after a transurethral enucleation of a prostate adenoma.

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Section: Discussionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Elshal

Mekkawy

Laymon

et al. 2015

CUAJ

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“…The equipment used was: an 100-W holmium: YAG (yttrium aluminium garnet) laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA); a 550-nm end-fi ring fi bre (SlimLineTM 550, Lumenis Inc.); a modifi ed continuous-fl ow 26-F resectoscope with a distal bridge; a 6-F catheter through the proximal bridge to stabilise the laser fi bre; continuous saline irrigation; a rigid indirect nephroscope with a 5-mm working channel; a tissue morcellator (Lumenis Inc.); and a video system. In group-I, HoLEP was performed as described previously [ 5,10 ] . Briefl y, a plane was created between the adenoma and the surgical capsule early after the fi rst incision of the gland from the bladder neck to the level of the verumontanum.…”

Section: Surgical Techniquementioning

confidence: 99%

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

2012

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E 8 4 5What ' s known on the subject? and What does the study add? The major advantage of holmium laser enucleation of the prostate (HoLEP) depends on the ability to use the native anatomical plane between the prostate adenoma and surgical capsule, peeling each prostatic lobe from the capsule. HoLEP is associated with less catheterisation time, hospital stay and blood loss than transurethral resection of the prostate (TURP) or open prostatectomy. Urodynamic relief of obstruction has been reported to be better with HoLEP than TURP. However, surgical treatment of recurrent prostatic obstruction after previous transurethral surgery for symptomatic benign prostatic hyperplasia is more challenging because of loss of anatomical landmarks resulting in either incomplete removal or incontinence.HoLEP for recurrent symptoms due to residual or re-growing prostatic adenoma seems to be as safe, feasible and effi cient as HoLEP for de novo cases. The surgical plane between the adenoma and the surgical capsule was still accessible resulting in a durable long-term outcome with minimal side-effects. Previous transurethral prostatic surgery is not a contraindication for HoLEP. OBJECTIVE• To assess the technical feasibility, functional outcome and morbidity of holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia (BPH) in patients with previous transurethral prostate surgery. ' Redo ' surgery for recurrent or residual BPH poses a technical challenge with uncertain outcome as a result of disturbed anatomical landmarks with no clear surgical limits. PATIENTS AND METHODS• We retrospectively reviewed 1054 patients who underwent HoLEP for symptomatic BPH.• Patients were stratifi ed into two groups, group-I with no previous prostate surgery or primary-HoLEP (978 patients) and group-II with history of previous prostate surgery or secondary-HoLEP (76).• All patients ' variables as well as follow-up data were assessed and compared. RESULTS• There were no signifi cant differences in baseline criteria between the two groups ( P > 0.05).• In group-II, HoLEP was done after a median (range) of 66 (13 -121) months from previous prostate surgeries, including transurethral resection of the prostate (48 patients), HoLEP (eight), transurethral incision of the prostate (nine), photoselective vaporization of the prostate (four) and other procedures (seven).• In both groups, routine HoLEP technique was adopted, the plane of enucleation could be identifi ed without extra diffi culty. However, more energy per gram of prostate tissue was needed in group-II ( P < 0.05).• Operative auxiliary procedures were indicated in 1.9% of group-I, and 1.3% of group-II ( P > 0.05). There were no operative complications or blood transfusion in group-II. The mean hospital stay and catheter time was similar in both groups. Early and late postoperative complications were not statistically different ( P > 0.05).• At 1 month the mean maximum urinary fl ow rate (Q max ) was 22.3 and 18.8 mL/s, postvoid residual urine volume (PVR) was 4...

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“…HoLEP entails retrograde laser-assisted dissection of the prostatic adenoma into the bladder followed by intravesical morcellation [8]. The equipment used includes A 100-W Holmium: YAG laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA), 550-um end-firing flexible fiber (SlimLineTM 550, Lumenis Inc.), and Piranha tissue morcellator with reusable blades (Richard Wolf Inc.).…”

Section: Interventionmentioning

confidence: 99%

Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?

et al. 2015

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Holmium Laser Enucleation of the Prostate: Modified Technical Aspects

Cited by 48 publications

References 14 publications

Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?

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