Impact of metabolic syndrome on pre- and postoperative parameters in patients undergoing a HoLEP surgery

Abstract

Objective: We aimed to investigate the safety and success of the holmium laser enucleation of prostate (HoLEP) surgery in patients with metabolic syndrome (MS) versus those without MS who have similar prostate sizes. Material and methods: Data from 120 patients who underwent HoLEP by a single surgeon between November 2015 and January 2018 were prospectively analyzed. Group 1 (n=40) and Group 2 (n=80) consisted of patients with and without MS, respectively. Preoperative-and postoperative third month control variables that were compared between the groups included hemoglobin (Hb) level; International Prostate Symptom Score (IPSS); uroflowmetry parameters, such as maximum flow rate (Qmax) and average flow rate (Qave); post-voiding residue (PVR); voiding time (VT); and time to maximum flow rate (MVT). Results: For postoperative outcomes between the groups, only hospitalization time (HT) was significant among IPSS, Qmax, Qave, PVR, VT, MVT, Hb decrease, and catheterization time (p= 0.03). A multivariate analysis showed that the triglyceride level positively correlated with HT among Group 1 patients (p= 0.03). Perioperative outcomes, such as enucleated tissue weight, efficiency of enucleation, enucleation rate, efficiency of morcellation, enucleation time, morcellation time, total operation time, total laser energy, and laser efficiency, were compared as non-significant between the two groups (p>0.05). Conclusion: We found that HoLEP can be considered a safe and effective surgical treatment for patients with MS.

Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices

“…In addition, higher prostate tissue density resulted in significantly lower morcellation efficiency compared to low tissue density (9.81 vs 7.45 g/min; p = 0.0003) [33]. There was no significant difference in morcellation efficiency between patients with and without metabolic syndrome (5.09 vs 4.08 g/min; p = 0.9) [34].…”

“…The mean patient age was 67.4 (range 61.4-72.8) yr. The Piranha morcellator was used in 13 studies for treatment of 2644 patients [23,[25][26][27][28][29][30][31][36][37][38][39][40], while VersaCut was utilized in 17 studies in treating 2907 patients [16][17][18][19][20][21][22]24,[33][34][35][36][37][38][39][40][41]. The DrillCut device was investigated in two studies for treatment of 101 patients [32,41].…”

“…Six studies were of comparative nature, with comparison of Piranha versus VersaCut in five [36][37][38][39][40] and of DrillCut versus VersaCut in one [41]. The remaining 20 studies investigated a single morcellator and partly included subgroups to compare, for example, different blade types [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Table 1 presents a summary of patient demographics, baseline characteristics, and perioperative outcomes.…”

“…The VersaCut system had a weighted mean morcellation efficiency of 3.95 (range 1.93-9.81) g/min [16][17][18][19][20][21][22]24,[33][34][35][36][37][38][39][40][41]. No significant difference in morcellation efficiency between the upward and inverse techniques was found HoLEP is an effective and relatively safe surgical procedure for BPH.…”

“…All studies except those by Pirola et al [30] and Aydo gan et al [34] reported on bladder wall injury and/or morcellator malfunction.…”