Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB).

Methods

Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 ( n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 ( n = 85). The primary outcome was successful HoLEP.

Results

There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 ( p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups.

Conclusions

In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.

Related collections

Most cited references 17

Record: found
Abstract: found
Article: not found

Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up.

Richard Naspro, Nazareno Suardi, Andrea Salonia … (2006)

Prospectively evaluate perioperative outcomes and 2-yr follow-up after holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for treating benign prostatic hyperplasia-related obstructed voiding symptoms, with prostates >70 g. From March 2003 to December 2004, 80 consecutive patients were randomised for surgical treatment with HoLEP (n=41) or standard OP (n=39). All patients were preoperatively assessed with International Prostate Symptom Score and International Index of Erectile Function questionnaires and complete urodynamic evaluation. Intraoperative and perioperative parameters such as blood loss, catheter removal, and hospital stays were assessed. Early and late complications were recorded. Patients were evaluated at 1-, 3-, 12-, and 24-mo follow-ups with the same tests. Operating room time was significantly shorter for the OP group (72.09+/-21.22 min vs. 58.31+/-11.95 min, p<0.0001); catheter removal (1.5+/-1.07 d and 4.1+/-0.5 d, p<0.001) and hospital stay (2.7+/-1.1 d vs. 5.4+/-1.05 d, p<0.001) were shorter in the HoLEP group. Blood loss was less and blood transfusions fewer in the HoLEP group (p<0.001). In both groups urodynamic and uroflowmetry findings improved from baseline, were still evident at the 24-mo follow-up, and were comparable between the two groups. Late complications were also comparable. HoLEP is a feasible technique for treating large prostates. Functional results are similar to OP at the 2-yr follow-up. Reduced catheterisation, hospital stay, and blood loss make HoLEP an attractive option for the treatment of large prostates.

0 comments Cited 58 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.

Hemendra N Shah, Amol P Mahajan, Sunil S Hegde … (2007)

To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. We analysed the patients' demographic, peri-operative and follow-up data, and the complications during and after surgery. HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re-catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%). There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient.

0 comments Cited 45 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

PROMIS — Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer☆

A. El-Shater Bosaily, C. Parker, L.C. Brown … (2015)

Background Transrectal ultrasound-guided prostate biopsies are prone to detection errors. Multi-parametric MRI (MP-MRI) may improve the diagnostic pathway. Methods PROMIS is a prospective validating paired-cohort study that meets criteria for level 1 evidence in diagnostic test evaluation. PROMIS will investigate whether multi-parametric (MP)-MRI can discriminate between men with and without clinically-significant prostate cancer who are at risk prior to first biopsy. Up to 714 men will have MP-MRI (index), 10–12 core TRUS-biopsy (standard) and 5 mm transperineal template mapping (TPM) biopsies (reference). The conduct and reporting of each test will be blinded to the others. Results PROMIS will measure and compare sensitivity, specificity, and positive and negative predictive values of both MP-MRI and TRUS-biopsy against TPM biopsies. The MP-MRI results will be used to determine the proportion of men who could safely avoid biopsy without compromising detection of clinically-significant cancers. For the primary outcome, significant cancer on TPM is defined as Gleason grade >/= 4 + 3 and/or maximum cancer core length of ≥ 6 mm. PROMIS will also assess inter-observer variability among radiologists among other secondary outcomes. Cost-effectiveness of MP-MRI prior to biopsy will also be evaluated. Conclusions PROMIS will determine whether MP-MRI of the prostate prior to first biopsy improves the detection accuracy of clinically-significant cancer.

0 comments Cited 42 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Chris Bell:

ORCID: http://orcid.org/0000-0002-3587-5339

+44 300 085 8045 , christopher.bell@wales.nhs.uk

Sacha L. Moore: +44 300 085 8045 , sacha.moore@wales.nhs.uk

Amarit Gill: +44 300 085 8045 , amarit.gill@wales.nhs.uk

Obinna Obi-Njoku: +44 300 085 7872 , obi-njoku.joseph@wales.nhs.uk

Stephen F. Hughes: +44 300 085 8045 , stephen.hughes6@wales.nhs.uk

Asad Saleemi: +44 1582 718041 , asad.saleemi@ldh.nhs.uk

Gidon Ellis: +44 1582 718041 , super_iqi@yahoo.com

Farooq Khan: +44 1582 718041 , mrfarooqkhan.secretary@btinternet.com

Iqbal S. Shergill: +44 300 085 7872 , Iqbal.shergill@wales.nhs.uk

Journal

Journal ID (nlm-ta): BMC Urol

Journal ID (iso-abbrev): BMC Urol

Title: BMC Urology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2490

Publication date (Electronic): 22 October 2019

Publication date PMC-release: 22 October 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 97

Affiliations

[1 ]ISNI 0000 0000 8813 3684, GRID grid.416270.6, Department of Urology, , Wrexham Maelor Hospital, ; Wrexham, Wales, UK

[2 ]North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP UK

[3 ]GRID grid.412935.8, Department of Urology, , Luton and Dunstable University Hospital, ; Lewsey Road, Luton, LU4 0DZ UK

Author information

Chris Bell http://orcid.org/0000-0002-3587-5339

Article

Publisher ID: 523

DOI: 10.1186/s12894-019-0523-z

PMC ID: 6805368

SO-VID: 974fc9db-16b4-4638-a255-e92760313d12

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 May 2019

Date accepted : 20 September 2019

Custom metadata

ScienceOpen disciplines: Urology

Keywords: holmium laser enucleation of the prostate (holep),benign prostatic enlargement (bpe),transperineal template biopsy,prostate,lower urinary tract symptoms (luts),urinary retention

Data availability:

ScienceOpen disciplines: Urology

Keywords: holmium laser enucleation of the prostate (holep), benign prostatic enlargement (bpe), transperineal template biopsy, prostate, lower urinary tract symptoms (luts), urinary retention

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Cited by 1

Pre- and peri-operative clinical information, physiological observations and outcome measures following flexible ureterorenoscopy (FURS), for the treatment of kidney stones. A single-centre observational clinical pilot-study in 51 patients
Authors: Stephen Hughes, Alyson Jayne Moyes, Kevin Jones …

See all cited by

Most referenced authors 313

See all reference authors

Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

Efficacy of Communicating Science

Most cited references 17

Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up.

Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.

PROMIS — Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer☆

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 576

Cited by 1

Most referenced authors 313