Dataset Information

The en bloc method is feasible for beginners learning to perform holmium laser enucleation of the prostate

ABSTRACT:

Background

Holmium laser enucleation of the prostate (HoLEP) is a new alternative method for the treatment of benign prostatic hyperplasia (BPH); however, most surgeons are hesitant to use this new technique due to its steep learning curve. Notably, most beginners start with the traditional multi-incisional method rather than the en bloc method. Thus, we sought to explore the feasibility of beginners adopting the en bloc method in HoLEP.

Methods

A clinical development project was established at Department of Urology, Affiliated Nantong Rehabilitation Hospital of Nantong University in December 2019 to promote HoLEP. The study included 1st 132 consecutive patients treated by a single surgeon between January and December 2020. The overall pre-, peri-, and post-operative metrics were documented and evaluated. The 132 patients were divided into Group A (1st 50 patients) and Group B (the following 82 patients), and these two groups were compared to each other.

Results

No conversion of operative methods occurred. The major significant differences between Groups A and B related to the enucleation time and enucleation efficiency. We found that 20–30 procedures needed to be performed for the surgeon to become relatively comfortable with the en bloc method. Further, skill improvement was continuous but tended to stabilize with case accumulation. The main short-term complications observed in the hospital and 30 days post-operatively included acute urinary retention, urinary tract infection, transient incontinence, and gross hematuria. In the 18-month follow-up period, the complications consisted of urethral stricture and bladder-neck contracture, which required endoscopic urethrotomy or bladder-neck incisions.

Conclusions

The en bloc HoLEP provided a significantly improved voiding with low complications and recurrence, and this technique could feasibly be adopted to teach beginners.

SUBMITTER:

PROVIDER: S-EPMC10080358 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely.MethodsEnucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance.ResultsThe distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder.ConclusionThis video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.