Abstract
Purpose
To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP.
Methods
Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients’ characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups.
Results
Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Q max at 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP.
Conclusion
Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.
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References
Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140
Cornu JN (2016) Bipolar, monopolar, PVP, HoLEP: how to choose what’s best ? Urol Clin N Am 43(3):377–384
Cornu J-N, Ahyai S, Bachmann A et al (2014) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096
Hueber P-A, Ben-Zvi T, Liberman D et al (2012) Mid-term outcomes of initial 250 case experience with GreenLight 120W-HPS photoselective vaporization prostatectomy for benign prostatic hyperplasia: comparison of prostate volumes < 60 cc, 60 cc–100 cc and > 100 cc. Can J Urol 19:6450–6458
Rieken M, Bachmann A, Shariat SF (2016) Long-term follow-up data more than 5 years after surgical management of benign prostate obstruction: who stands the test of time? Curr Opin Urol 26(1):22–27
Van Rij S, Gilling P (2015) Recent advances in treatment for Benign Prostatic Hyperplasia. F1000Res 4. doi:10.12688/f1000research.7063.1
Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33(1):69–72
Gilling PJ (2013) Laser enucleation is increasingly becoming the standard of care for treatment of benign prostatic hyperplasia of all sizes. Eur Urol 63(5):868–869
Lerner LB, Rajender A (2015) Laser prostate enucleation techniques. Can J Urol 22(Suppl 1):53–59
Kahokehr A, Gilling PJ (2014) Enucleation techniques for benign prostate obstruction: which one and why? Curr Opin Urol 24(1):49–55
Brunckhorst O, Ahmed K, Nehikhare O et al (2015) Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures. Urology 86(4):824–829
Robert G, Cornu JN, Fourmarier M et al (2016) Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int 117(3):495–499
Gomez Sancha F, Rivera VC, Georgiev G et al (2015) Common trend: move to enucleation—is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33(4):539–547
Misrai V, Kerever S, Phe V et al (2015) Direct comparison of GreenLight laser XPS photoselective prostate vaporization and GreenLight laser en bloc enucleation of the prostate in enlarged glands greater than 80 ml: a study of 120 patients. J Urol 195(4P1):1027–1032
Tan AH, Gilling PJ (2002) Holmium laser prostatectomy: current techniques. Urology 60(1):152–156
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Mitropoulos D, Artibani W, Graefen M et al (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349
Gravas S, Bachmann A, Reich O et al (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043
Gilling PJ, Cass CB, Malcolm AR et al (1995) Combination holmium and Nd:yAG laser ablation of the prostate: initial clinical experience. J Endourol 9(2):151–153
Herrmann TR (2016) Enucleation is enucleation is enucleation is enucleation. World J Urol 34(10):1353–1355
Kyriazis I, Świniarski PP, Jutzi S et al (2015) Transurethral anatomical enucleation of the prostate with Tm:yAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol 33(4):525–530
Razzak M (2013) BPH: HoLEP—a steep learning curve but better for patients. Nat Rev Urol 10(2):66
Seki N, Mochida O, Kinukawa N, Sagiyama K, Naito S (2003) Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol 170:1847–1855
Misraï V, Faron M, Guillotreau J et al (2014) Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort. World J Urol 32(2):539–544
Rasch A, Gruber S, Perleth M (2013) Learning curve in laser treatment of benign prostatic syndrome: a systematic review. Z Evid Fortbild Qual Gesundh 107(4–5):335–343
Shah HN, Sodha HS, Kharodawala SJ et al (2008) Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int 101(12):1536–1541
Cho MC, Park JH, Jeong MS et al (2011) Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 30(7):1343–1349
Authors’ contribution
B. Peyronnet performed protocol/project development, data analysis and manuscript writing/editing. G. Robert perforemed protocol/project development, data collection or management, data analysis and manuscript writing/editing. V. Comat performed data collection or management. M. Roupret performed data collection or management, data analysis and manuscript writing/editing. F. Gomez-Sancha performed manuscript writing/editing. J.-N. Cornu performed protocol/project development data analysis and manuscript writing/editing. V Misrai performed manuscript writing/editing, protocol/project development, data collection or management and data analysis.
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Benoit Peyronnet and Grégoire Robert have contributed equally to this work.
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Peyronnet, B., Robert, G., Comat, V. et al. Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 35, 973–983 (2017). https://doi.org/10.1007/s00345-016-1957-5
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DOI: https://doi.org/10.1007/s00345-016-1957-5