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A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group

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Abstract

Purpose

Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure.

Methods

The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts’ feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth.

Results

Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o’clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa.

Conclusion

To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.

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Author information

Authors and Affiliations

  1. Department of Urology, Acibadem University School of Medicine, Ankara, Turkey

    Lutfi Tunc

  2. Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland

    Thomas Herrmann

  3. Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey

    Selcuk Guven

  4. Department of Urology, Cottolengo Hospital, Turin, Italy

    Cesare Marco Scoffone

  5. Department of Urology, ASST Valle Olona, Busto Arsizio, Italy

    Giorgio Bozzini

  6. Department of Urology, Kolan Hospital, Istanbul, Turkey

    Sercan Yilmaz

  7. Department of Urology, Hospital Universitario, 12 de Octubre, Madrid, Spain

    Javier Romero-Otero

  8. Department of Urology, Clinique Pasteur, 31300, Toulouse, France

    Vincent Misrai

  9. Department of Urology, Policlinico Abano Terme, Abano Terme, Italy

    Angelo Porreca

  10. Department of Urology, Medical University of Graz, Graz, Austria

    Sacha Ahyai

  11. Department of Urology, Medius-Kliniken Ruit, University of Tubingen, Ostfildern, Germany

    Ali Serdar Gozen

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  1. Lutfi Tunc
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Contributions

LT: protocol/project development, data collection or management, data analysis, manuscript writing/editing TH: protocol/project development, data analysis, manuscript writing/editing, SG: data collection or management, data analysis, manuscript writing/editing, CMS: protocol/project development, data analysis, manuscript writing/editing, GB protocol/project development, data analysis, manuscript writing/editing, SY: protocol/project development, data collection or management, data analysis, manuscript writing/editing, JRO: protocol/project development, data analysis, manuscript writing/editing, VM: protocol/project development, data analysis, manuscript writing/editing, AP: protocol/project development, data analysis, manuscript writing/editing, SA: protocol/project development, data analysis, manuscript writing/editing, ASG: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Ali Serdar Gozen.

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Tunc, L., Herrmann, T., Guven, S. et al. A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group. World J Urol 41, 2303–2309 (2023). https://doi.org/10.1007/s00345-023-04496-8

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  • DOI: https://doi.org/10.1007/s00345-023-04496-8

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