Retrospective Assessment of Endoscopic Enucleation of Prostate Complications: A Single-Center Experience of More Than 1400 Patients

Morozov, Andrey; Taratkin, Mark; Kozlov, Vasiliy; Tarasov, Alexander; Безруков, Е. А.; Enikeev, Mikhail; Afyouni, Andrew Shea; Okhunov, Zhamshid; Glybochko, Petr; Enikeev, Dmitry

doi:10.1089/end.2019.0630

Cited by 33 publications

(22 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…28 In a randomized study, ThuFLEP was compared with HoLEP and MEP. 22 The authors found that ThuFLEP was associated with simple learning curve, achieving proficiency in as few as [8][9][10][11][12][13][14][15][16] procedures. This illustrates a key advantage over HoLEP which typically requires 50-60 procedures.…”

Section: Prostate Laser Enucleationmentioning

confidence: 99%

“…The theoretical benefits of TFL have seen its application outside of stone surgery, in soft tissue surgery such as BPE and bladder tumour en-bloc resection. 7,8 TFL has demonstrated efficacy and safety in ex vivo research and is now being deployed in clinical research. 9,10 One advantage of TFL is its higher water-absorption coefficient compared with Ho:YAG, which means that water absorbs TFL energy around four times higher than it does with Ho:YAG laser energy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

Rice

Somani²

2021

RRU

View full text Add to dashboard Cite

Laser technology is widely used in urological surgery, from lithotripsy, prostate surgery to en-bloc resection of tumours. While Holmium:YAG has been widely employed over the last two decades, in recent years, there has been a surge of interest in Thulium Fiber Laser (TFL), which offers theoretical advantages of better water absorption and lower stone ablation thresholds. A systematic review was conducted to assess the evidence from clinical research on TFL's application for lithotripsy and prostate surgery. It identified 357 articles and 8 (1506 patients) were selected, of which 4 clinical studies each investigated TFL enucleation of prostate (ThuFLEP) and TFL lithotripsy. For flexible ureteroscopic lithotripsy (FURSL), stone ablation settings ranged from 0.1-4 J, and 7-300 Hz, mean operative time ranged from 23.4-39.8 minutes and lasing time ranged from 1.2-10 minutes. For stone dusting in percutaneous nephrolithotomy (PCNL), settings of 0.2 J and 125-200 Hz were found to be optimal. For ThuFLEP, all studies showed a significant improvement in IPSS (International Prostate Symptom Score), urinary flow rate (Q max ), quality of life measures, and post-void residual volume, with mean operative time ranging from 67-104.5 minutes. Our review shows that there is limited evidence on the use and clinical outcomes of TFL. ThuFLEP might suggest equivalence to the widely used HoLEP in the available evidence so far. TFL lithotripsy shows promising results but further prospective, randomized trials are required to properly assess its usability, clinical effectiveness and standardisation of the settings for successful adoption of the technology.

show abstract

Section: Prostate Laser Enucleationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

Rice

Somani²

2021

RRU

View full text Add to dashboard Cite

show abstract

“…The most important features determining this are wavelength (resulting in tissue penetration depth) and peak impulse energy 19 . TFL safety has been previously shown in large samples of endoscopic enucleation of the prostate 20 and bladder tumor resection 21 with long‐term follow‐up. Although Ho:YAG laser lithotripsy very seldom leads to ureteral injury, such cases have been reported 22 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objectives To estimate the efficacy and safety of SuperPulsed thulium‐fiber laser ureteral lithotripsy and to identify optimal laser settings. Methods Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium‐fiber laser (NTO IRE‐Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser‐on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three‐point Likert scale. Complications were assessed using the Clavien–Dindo classification system. Results A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94–357) mm3. The median (interquartile range) total energy was 1 (0.4–2) kJ, and laser‐on time 1.2 (0.5–2.7) min. The median (interquartile range) stone ablation speed was 140 (80–279) mm3/min, energy for ablation of 1 mm3 was 5.6 (3–9.9) J/mm3 and energy consumption was 0.9 (0.6–1) J/min. A correlation was found between retropulsion and the energy used (r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6–2774.1; P = 0.028). No predictors for worse visibility were identified. Conclusion The SuperPulsed thulium‐fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting.

show abstract

“…Although these new techniques might offer sufficient Abbreviations: BPH, benign prostatic hyperplasia; TPLA, transperineal percutaneous laser ablation; TURP, transurethral resection of the prostate; RCT, randomised controlled trial; RDC, remote data capture; LUTS, lower urinary tract symptoms; IPSS, International Prostate Symptom Score; IWRS, Interactive Web Response System; QoL, quality of life; EQ-5D, European five-dimensional health scale; VAS, visual analogue score; ECG, electrocardiograph; PSA, prostate specific antigen; TRUS, transrectal ultrasonography; MRI, magnetic resonance imaging; AE, adverse event; SAE, serious adverse event; IIEF-5, International Index of Erectile Function-5; MSHQ-EjD, Male Sexual Health Questionnaire-Ejaculatory Dysfunction; eCRF, electronic case report form. efficacy and lower risk of complications over standard bipolar-TURP (27,28), However, the levels of evidence are too low and follow-up still too short to offer solid recommendations, and larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes (22,29). And since the surgical approach are transurethral avoiding injury is challenging, and haematuria and urethral stricture may occur after the operation (30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, lasers are non-conductive; thus, they can be applied in patients with heart pacemakers and other electric implants. Although these new techniques might offer sufficient efficacy and lower risk of complications over standard bipolar-TURP ( 27 , 28 ), However, the levels of evidence are too low and follow-up still too short to offer solid recommendations, and larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes ( 22 , 29 ). And since the surgical approach are transurethral avoiding injury is challenging, and haematuria and urethral stricture may occur after the operation ( 30 – 33 ).…”

Section: Introductionmentioning

confidence: 99%

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

Zhang

Guo

et al. 2021

Front. Surg.

View full text Add to dashboard Cite

Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent.Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure.Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients.Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].

show abstract

Retrospective Assessment of Endoscopic Enucleation of Prostate Complications: A Single-Center Experience of More Than 1400 Patients

Cited by 33 publications

References 17 publications

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

Contact Info

Product

Resources

About