Laser enucleation of the prostate in men with very large glands ≥175 ml: A systematic review

A single‑office experience of day‑case water vapor thermal therapy for benign prostatic hyperplasia

“…No case required unscheduled post-operative visits or hospitalization. These results suggest that day-case, office-based WVTT is feasible, similar to other minimally invasive therapies for BPH (10,15,16). In the present study, spinal anesthesia was applied on all procedures, and all patients could leave the office in ~4 h on the day of the procedure.…”

“…Although TURP has demonstrated efficacy in improving urinary symptoms, acute complications and long-term adverse events (AEs), such as erectile and ejaculatory dysfunction, incontinence, and other complications have been reported (5). Some studies have indicated the efficacy and safety of a wide variety of minimally invasive procedures for BPH, such as laser endoscopic enucleation, green light vaporization, prostatic artery embolization and UroLift (6)(7)(8)(9)(10). All these procedures aim at avoiding or reducing complications associated with TURP, while maintaining comparable outcomes.…”

“…A recent randomized clinical trial reported the safety and durable efficacy of WVTT performed in an office-based or ambulatory surgery center (12). The provision of day-case surgery would allow for greater patient flow and improve clinical care through increased efficiency (10).…”

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

“…This is also pertinent to EEP in large prostates. Interestingly, the authors in a recent systematic review recorded better postoperative functional outcomes in prostates with a volume of ≥ 175, > 200 and > 300 ml, respectively, with a retreatment rate of only 0–1.3% [ 16 ]. However, the authors could not make deductions from the pooled data on which technique is better for large and very large prostates.…”

Commentary on “Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate”

“…It is very difficult to agree with the conclusion that the risk of electro-coagulation increases in patients with transitional zone volume >35 mL. HoLEP is indicated for large volume adenoma [ 2 ] and the proposed odds ratio for need for coagulation of 5.17 in ≥53.5-mL adenoma appears very high. The very fact that most recent guidelines propose HoLEP as a treatment of choice for large prostate volumes and for patients on antiplatelet or anticoagulant medications is a testament for its coagulation capabilities [ 3 ].…”