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      Efficacy and Safety of X-incision with Inversed Morcellation in Holmium Laser Enucleation of the Prostate: Comparison to Conventional Morcellation

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          Abstract

          Background

          Three-quarters of aged men experience lower urinary tract symptoms with benign prostate hypertrophy (BPH). Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) are standard endosurgical procedures in patients with BPH. Previous studies reported better results in patients undergoing HoLEP than in those undergoing TURP.

          Methods

          This study compared the efficiency and safety of conventional morcellation and morcellation performed after X-incision during enucleation, a newly added technique in HoLEP. Overall, 174 patients were selected as the final study population. The populations were stratified with respect to resected volumes. A t-test were used to compare the conventional morcellation and X-incision procedure groups.

          Results

          In morcellation times and rates, there were significant differences in stratified resected mass (g) between the groups. The results also showed a decreased incidence of bladder injury as a surgical complication.

          Conclusion

          We believe morcellation performed after X-incision procedure during enucleation is efficient and safe for older adults with BPH.

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          Most cited references14

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          Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial.

          To report 3-yr follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP). A total of 200 patients with urodynamic obstruction and a prostate volume of less than 100 cc were prospectively randomised and assigned to HoLEP or TURP. All patients were assessed preoperatively and followed at 1, 6, 12, 18, 24, and 36 mo postoperatively. American Urological Association Symptom Score (AUA SS), maximum flow rate (Q(max)), and postvoid residual (PVR) [urine] volume were obtained at each follow-up. Perioperative data and postoperative outcome were compared. All complications were recorded. AUA SS were significantly better 2 yr postoperatively in the HoLEP group (1.7 vs. 3.9, p<0.0001) and similar at 3 yr (2.7 vs. 3.3, p=0.17). PVR volume was significantly better 2 yr (5.6 vs. 19.9 ml, p<0.001) and 3 yr (8.4 vs. 20.2 ml, p=0.012) postoperatively in HoLEP patients. Q(max) was similar in the HoLEP and TURP groups at 2 yr (28.0 vs. 29.1 ml/s, p=0.83) and at 3 yr (29.0 vs. 27.5 ml/s, p=0.41) postoperatively. Late complications consisted of urethral strictures, bladder-neck contractures, and BPH recurrence; reoperation rates were 7.2% in the HoLEP and 6.6% in the TURP group (p=1.0). After 2 and 3 yr of follow-up, HoLEP micturition outcomes compare favourably with TURP. Late complications are equally low. HoLEP may be a real alternative to TURP.
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            Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience.

            The preliminary experience with 64 patients who have undergone HoLEP combined with intravesical morcellation is presented. The mean preoperative prostate volume was 75.3 cc. The mean laser time was 46.9 minutes and the morcellator time a further 10.5 minutes. A mean total of 35.5 g of tissue was obtained, and 93% of the patients were discharged the day after their surgery without a catheter. The American Urological Association Symptom Score at 1 month was 8.6 and the peak flow rate 23.4 mL/sec. This combination of procedures allows prostate glands of virtually any size to be safely treated transurethrally, and a complete anatomic enucleation of the prostatic adenoma is achieved.
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              Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience.

              The holmium laser is a recent addition to the urologist's armamentarium, being used primarily for the destruction of urinary calculi. Its use as a tool for ablation of the prostate has not been previously described. Our initial experience with 110 patients who have undergone a combination procedure using the Nd:YAG laser for standard circumferential coagulation followed by holmium laser ablation is reported. A further 32 patients who have had a holmium-only technique are described. In the patients who had the combination technique, the AUA Symptom Score improved from a mean value of 19.8 preoperatively to 7.8 at 3 months. The peak urine flow rate likewise improved, from a mean of 8.9 mL/sec preoperatively to 15.1 mL/sec at 3 months. Only one patient who had the holmium-only technique required recatheterization, compared with nine patients who had the combination procedure. The combination Ho/Nd:YAG laser ablation technique is evolving. The early results of the holmium-only technique suggest an advantage over the combination with regard to catheterization time and degree of irritative symptoms. The longer-term results must be assessed to confirm this impression.
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                Author and article information

                Journal
                Ann Geriatr Med Res
                Ann Geriatr Med Res
                AGMR
                Annals of geriatric medicine and research
                Korean Geriatrics Society
                2508-4798
                2508-4909
                September 2019
                27 September 2019
                : 23
                : 3
                : 149-154
                Affiliations
                Department of Urology, National Medical Center, Seoul, Korea
                Author notes
                Corresponding Author: Woong Na, MD, PhD Department of Urology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea E-mail: woong224@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-9871-8835
                Article
                agmr-19-0031
                10.4235/agmr.19.0031
                7370769
                0f55d8d3-a9f2-4b22-930e-7fe279503c8b
                Copyright © 2019 Korean Geriatrics Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 August 2019
                : 13 September 2019
                : 18 September 2019
                Categories
                Original Article

                holep,morcellation,bph,enucleation
                holep, morcellation, bph, enucleation

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