Hahn-Ey Lee

Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia.

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.

HoLEP does not affect the overall sexual function of BPH patients: a prospective study

We aimed to prospectively evaluate the influence of holmium laser enucleation of the prostate (HoLEP) on the overall postoperative sexual function of benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and to explore the relationship between sexual function and LUTS. From January 2010 to December 2011, sixty sexually active consecutive patients with BPH who underwent HoLEP were prospectively enrolled in the study. All patients filled out the Male Sexual Health Questionnaire (MSHQ) for evaluation of their overall sexual function and the International Prostatic Symptom Score (IPSS) for pre- and post-operative 6 months evaluation of their voiding symptoms. The LUTS and sexual function changes were statistically analyzed. The preoperative and 6 months postoperative status of the patients was compared using uroflowmetry and IPSS questionnaires. The analysis revealed significant improvements following HoLEP. Among the sub-domains of the MSHQ, postoperative sexual function, including erection, ejaculation, sexual satisfaction, anxiety or sexual desire, did not significantly change after HoLEP (P > 0.05), whereas satisfaction scores decreased slightly due to retrograde ejaculation in 38 patients (63.3%). Sexual satisfaction improved significantly and was correlated with the improvements of all LUTS and the quality-of-life (QoL) domains in IPSS after surgery (QoL; relative risk [RR]: −0.293; total symptoms, RR: −0.411; P < 0.05). The nocturia score was associated with the erectile function score (odds ratio 0.318, P = 0.029). The change in ejaculatory scores did not show significant association with IPSS scores. HoLEP did not influence overall sexual function, including erectile function. In addition, sexual satisfaction improved in proportion with the improvement of LUTS.

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Purpose To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. Materials and Methods Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL≤TPV<200 mL), and group C (TPV≥200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery. Results A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, ±7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7±36.9 mL and 4.15±4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. Conclusions HoLEP in patients with an extremely large prostate can be performed efficiently and safely.

Translation and Linguistic Validation of the Korean Version of the “Benefit, Satisfaction, and Willingness to Continue” Questionnaire for Patients With Overactive Bladder

Purpose The goal of this study was to develop a Korean version of the Benefit, Satisfaction, and Willingness to Continue (BSW) questionnaire from the original version, with subsequent linguistic validation by Korean patients with overactive bladder who undergo active treatment by a physician. Methods Translation and linguistic validation were performed in January 2013. The validation process included permission for translation, forward translation, reconciliation, backward translation, cognitive debriefing, and proofreading. Results During the forward translation process, the terms or phrases of ‘benefit,’ ‘willingness,’ “have you had any benefit?,” “taking all things into account” were adjusted to be more appropriate expressions in the Korean language than those used in the original version. During the backward translation process, no changes were made in terms of the sematic equivalence. In the cognitive debriefing session, 5 patients were asked to fill in the answers within 5 minutes; most reported that the translated questions were clear and easy to understand. One patient felt the questions were a little bit difficult to understand; however, the panel decided not to change the expressions because the overall level of comprehension was high and the translated terms were accurate enough to convey the meaning of the original version of the BSW. Conclusions The present study showed a successful linguistic validation of the BSW questionnaire. Further studies are needed to assess of the psychometric properties of the BSW.

2271 THE EFFECT OF HOLMIUM LASER ENUCLEATION OF PROSTATE ON NONSPECIFIC GENITOURINARY PAIN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: A PROSPECTIVE STUDY WITH URODYNAMIC CORRELATION

tion of urine at night (nocturnal polyuria, NPU). NPU is generally diagnosed in subjects aged 65 years when night time urine production exceeds 33% of the total 24 hour (h) urine production. Fedovapagon (VA106483), a novel non-peptide drug, is a selective vasopressin V2-receptor agonist in development for the treatment of nocturia. METHODS: Thirty older male subjects (aged 65 years) with a history of BPH and nocturia (mean age 69.2 years [SD 3.2]) were randomised in this IEC approved double-blind, placebo-controlled, five-way cross-over study. Each subject received five treatment periods, each of 2 nights, comprising 0.5 mg 1 mg 2 mg 4 mg fedovapagon and placebo administered in a double-blind fashion in a randomised treatment sequence, each separated by a 1 night singleblind placebo. Subjects had free access to fluid throughout the study, ensuring thirst was satisfied at all times. Subjects were dosed with Investigational Medicinal Product (IMP) at approximately 9 pm. Subjects were prompted to void 1 h post IMP (bedtime void) and again at 9 h (first morning void). Urine voided after the prompted bedtime void and up to and including the first morning void was included in the NUV. 24 h urine volume was assessed throughout the study period. Nocturnal polyuria index (NPUI) was calculated as NUV / 24 h urine volume 100%. RESULTS: There was no discernible effect of fedovapagon treatment on the overall 24 h urine volume. Fedovapagon reduced NPUI in a dose responsive manner from 37.1% following placebo to 24.6% at the 4 mg dose. Fedovapagon was effective on the first night of dosing. There was no apparent carry-over effect of fedovapagon on nocturnal polyuria indices during the single-blind treatment between randomised treatment periods. CONCLUSIONS: Fedovapagon treatment was well tolerated in the study population. The dose-responsive reduction in NPUI on fedovapagon shown in this study indicates a shift of urine production from the night time period to the daytime period in this population of older male subjects with nocturia and BPH.

2078 SURGICAL MANAGEMENT OF PELVIC ORGAN PROLAPSE IN FEMALES: ANATOMICAL AND FUNCTIONAL OUTCOMES OF SACROSPINOUS COLPOPEXY AND CYSTOCELE REPAIR AS A COMBINED PROCEDURE

INTRODUCTION AND OBJECTIVES: High stage cystocele usually occurs concomitantly with apical prolapse, and is likely to recur when only the cystocele is surgically corrected. We investigated the anatomical and functional outcome of patients who underwent sacrospinous colpopexy and cystocele repair simultaneously. METHODS: We retrospectively reviewed 71 consecutive women who underwent sacrospinous colpopexy and cystocele repair as a combined procedure and were followed up more than 12 months after surgery. Anti-incontinence surgery was performed when indicated. Severity of prolapse was assessed by the POP-Q staging system. Prolapse-related and lower urinary tact symptoms were assessed. Cystocele was corrected using designed mesh or mesh kits of Perigee or Prolift. For apical correction, sacrospinous ligament fixation was performed. Postoperatively, an anatomical assessment and standardized interview was performed at predetermined intervals. The primary outcome measure was anatomical cure rate. Anatomical cure was defined as stage I or less. Secondary outcomes included subjective cure, symptom status, subjective or objective stress urinary incontinence and uroflowmetric parameters. Women reporting they were never or rarely bothered by prolapse-related symptoms were classified as subjectively cured. RESULTS: All cystoceles were stage III or more and all apical prolapses were stage II or more preoperatively. The success rates of cystocele repair and apical wall repair were 76.1% and 97.2% at postoperative 1 year, respectively. Among the 17 patients in which cystocele recurrence occurred, 15 cases were in stage 2 and none of them showed apical prolapse recurrence or prolapse-related symptoms. There were only 2 cases in which cystocele recurrence occurred higher than stage 3, and all of them had simultaneous apical wall prolapse. In both of these cases, abdominal sacrocolpopexy was performed. Postoperatively, prolapse-related symptoms were completely improved and lower urinary tract symptoms were much improved. Maximal flow rates and postvoid residual urine volumes were significantly improved. De novo incontinence occurred in 23.3% of the patients who did not undergo anti-incontinence surgery simultaneously. All complications were managed conservatively. No mesh erosion was identified. CONCLUSIONS: When apical prolapse was corrected successfully, cystocele recurrence did not exceed stage 2 and no symptoms were identified. When apical correction was not successful, high stage cystocele recurrence occurred.