Abstract
Purpose
To report the functional outcomes, perioperative morbidity and surgical learning curve key points using “en bloc” greenlight enucleation of prostate (EB-GreenLEP) for patients with refractory lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).
Methods
Between December, 2015 and May, 2018, all consecutive patients with refractory LUTS due to BPH in our institution were included and underwent EB-GreenLEP by a single surgeon. Perioperative data, complications and functional outcomes at 1-, 6- and 12-month follow-ups were collected and retrospectively analyzed.
Results
One hundred patients were included whose median age was 69 years. The median prostate volume (PV) was 84 mL and median enucleated PV was 45.5 mL. Mean irrigation, catheterization and hospitalization times were 1.3, 1.4 and 1.6 days, respectively. Average follow-up was 9.3 months. A single high-grade Clavien-Dindo complication occurred. No urinary retention was reported. Two conversions to conventional resection of the prostate were noted. Three patients had postoperative urinary incontinence at 6 months, only one at 1 year (1%). At 1, 6 and 12 months, there was a significant improvement in IPSS score, QoL and Qmax. Enucleation and energy efficiency ratios were shorter after the 30th procedure. We demonstrated a linear correlation between enucleation time and PV (r = 0.53, p < 0.0001).
Conclusion
Our study shows that the mid-term functional results of EB-GreenLEP are comparable to other laser sources for the endoscopic enucleation of the prostate but with a shorter learning curve. We showed that, with (a) low rates of complications and a short hospital stay, EB-GreenLEP can manage medium-size glands (60–90 mL).
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References
Robert G, De La Taille A, Descazeaud A (2018) Epidemiology of benign prostatic hyperplasia. Prog En Urol J Assoc Francaise Urol Soc Francaise Urol 28(15):803–812
de la Taille A, Robert G, Descazeaud A (2018) Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery. Prog En Urol J Assoc Francaise Urol Soc Francaise Urol 28(15):813–820
Gravas S, Bach T, Bachmann A, Drake M, Gacci M, Gratzke C, Madersbacher S, Mamoulakis C, Tikkinen KAO (2018) Management of non-neurogenic male LUTS. EAU Guidelines. Edition presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2. Uroweb. http://www.uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/
Robert G, de la Taille A, Descazeaud A (2018) Surgical treatment of BPO: standard and innovations. Prog En Urol J Assoc Francaise Urol Soc Francaise Urol 28(15):856–867
Glybochko PV, Alyaev YG, Rapoport LM, Enikeev DV, Okhunov Z, Netsch C, Spivak LG, Taratkin MS (2018) Endoscopic enucleation of the prostate: a short term trend or a new treatment standard? Urologiia (2):130–133
Robert G, Cornu J-N, Fourmarier M, Saussine C, Descazeaud A, Azzouzi A-R et al (2016) Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int 117(3):495–499
Peyronnet B, Robert G, Comat V, Rouprêt M, Gomez-Sancha F, Cornu J-N et al (2017) Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 35(6):973–983
Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T (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
Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411
Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166
Ahyai SA, Lehrich K, Kuntz RM (2007) Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol 52(5):1456–1463
Enikeev D, Glybochko P, Rapoport L, Okhunov Z, O’Leary M, Potoldykova N et al (2018) Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 18(1):87
Gu M, Chen Y-B, Liu C, Wan X, Cai Z-K, Chen Q et al (2018) Comparison of holmium laser enucleation and plasmakinetic resection of prostate: a randomized trial with 72-month follow-up. J Endourol 32(2):139–143
Misraï V, Pasquie M, Bordier B, Elman B, Lhez JM, Guillotreau J et al (2018) Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience. World J Urol 36(5):793–799
Marchioni M, Cindolo L, Di Nicola M, Schips L, De Sio M, Lima E, Mirone V, Cormio L, Liatsikos E, Porpiglia F, Autorino R, EAU Section of Uro-Technology (ESUT) Research Group (2019) Major acute cardiovascular events after transurethral prostate surgery: a population-based analysis. Urology 131:196–203. https://doi.org/10.1016/j.urology.2019.05.014
Cho MC, Park JH, Jeong MS, Yi J-S, Ku JH, Oh S-J et al (2011) Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 30(7):1343–1349
Elkoushy MA, Elshal AM, Elhilali MM (2015) Reoperation after holmium laser enucleation of the prostate for management of benign prostatic hyperplasia: assessment of risk factors with time to event analysis. J Endourol 29(7):797–804
Hamid D, Casnedi S (2016) Tissue effect of Greenlight(®) laser on uterine fibroids. J Gynecol Obstet Biol Reprod 45(2):124–128
Cindolo L, Ruggera L, Destefanis P, Dadone C, Ferrari G (2017) Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the Greenlight laser. Int Urol Nephrol 49(3):405–411. https://doi.org/10.1007/s11255-016-1494-6(Epub 2017 Jan 2)
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Panthier, F., Pasquier, J., Bruel, S. et al. En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases. World J Urol 38, 1545–1553 (2020). https://doi.org/10.1007/s00345-019-02941-1
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DOI: https://doi.org/10.1007/s00345-019-02941-1