Mark Taratkin

RETROSPECTIVE ANALYSIS OF SHORT-TERM OUTCOMES AFTER MONOPOLAR VERSUS LASER ENDOSCOPIC ENUCLEATION OF THE PROSTATE: A SINGLE CENTER EXPERIENCE

INTRODUCTIONnEndoscopic enucleation of the prostate (EEP) has been recognized as a viable treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP, including monopolar enucleation (MEP), holmium laser enucleation of the prostate (HoLEP), and thulium laser enucleation of the prostate (ThuLEP).nnnMETHODSnThe study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP. Functional parameters were evaluated before and 6 months after surgery, which included the International Prostate Symptom Score, maximum flow rate, postvoid residual volume, prostate volume, and sodium levels of all patients.nnnRESULTSnA total of 551 men with the mean age of 67.1 years were included in the study. Of these, MEP was performed on 95 patients, HoLEP was performed on 254 patients, and ThuLEP on 202 patients. The mean mass of morcellated tissue obtained during the three techniques did not differ significantly (pu2009>u20090.05). Mean procedure times of ThuLEP and HoLEP were shorter than MEP demonstrating 72, 76, and 86 minutes, respectively (pu2009<u20090.01). The mean catheterization time following laser EEPs was shorter than MEP as shown by 1.3, 1.3, and 3.8 days, respectively (pu2009<u20090.01). Hospital stay times of HoLEP and ThuLEP were shorter than MEP demonstrated by 3.3, 3.4, and 6.9 days, respectively (pu2009<u20090.01). Patients after MEP had significant decrease in postoperative hemoglobin and sodium levels. All the groups showed statistically significant improvement in the aforementioned parameters following treatment.nnnCONCLUSIONSnBoth techniques of laser enucleation proved to be efficacious in the management of BPH. MEP of the prostate seems to be a highly promising addition to the list of enucleation techniques and was determined to be an effective and acceptable procedure, despite a higher complication rate.

A randomized trial comparing the learning curve of three endoscopic enucleation techniques (HoLEP, ThuFLEP and MEP) for BPH using mentoring approach – initial results

OBJECTIVEnTo assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate.nnnMATERIALS AND METHODSnNinety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume <80 cc, IPSS > 20, or Qmax < 10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP.nnnRESULTSnThuFLEP was slightly superior (with no significant difference [P > .05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P < .001) without significant difference between techniques of laser EEP (P = .07).nnnCONCLUSIONnEndoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.

A Feasibility Study Utilizing the Thulium and Holmium Laser in Patients for the Treatment of Recurrent Benign Prostatic Hyperplasia after Previous Prostatic Surgery

Background: Transurethral resection of the prostate (TURP) is considered to be the standard treatment for patients with benign prostatic obstruction (BPO) ≤80 mL. However, up to 14.7% of the patients require secondary TURP due to recurrent BPO. The aim of our study was to describe specific features of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in patients with recurrent BPO after previous prostate surgery. Materials and Methods: A total of 768 consecutive patients from our prospective collected database were retrospectively reviewed and divided into 4 groups: group A (489 patients) and group C (253 patients) underwent primary HoLEP and ThuLEP treatment, while group B (17 patients) and D (9 patients) included patients with recurrent BPO who were treated with HoLEP and ThuLEP, respectively. Results: There were no significant differences in preoperative parameters between the groups at primary (A and C) and secondary (B and D) treatment except their age. At 6-month follow-up, voiding parameters and symptom scores showed statistically significant improvements compared to baseline without differences between the groups. The mean operative time was comparable between the groups and did not differ significantly (p > 0.05). Conclusions: Laser enucleation for the treatment of recurrent BPO is feasible and seems to be a safe and effective procedure.

MP24-10 WAVELENGTH AND PULSE SHAPE EFFECTS ON STONE FRAGMENTATION OF LASER LITHOTRIPTERS

34 and 2, respectively. Compare to direct sequence, 9 patients were reclassified into the novel genotype. However, overall 19.6% of patients still not fit into an autosomal recessive inheritance, with 2 patients possessed no mutation. CONCLUSIONS: Among 51 patients, 8 novel mutations were identified and 9 patients were reclassified into a novel genotype. However, 20% of patients did not fit into autosomal recessive genotype. Current data may suggest the potential contribution of another factor in the pathogenesis of Cystinuria.

Comparative results of cryoablation and laparoscopic radical prostatectomy in the treatment of localized prostate cancer

Aim: To evaluate early prostate cancer cryoablation functional and oncological results in comparison with results of extraperitoneoscopic radical prostatectomy. Materials and methods: We analyzed early results of surgical treatment of 285 patients with prostate cancer: 42 of them had undergone total cryoablation (Group 1) while the rest of them had been treated by radical laparo- and extraperitoneoscopic prostatectomy. For comparative assessment of prostate cryoablation results, 42 patients from Group 2 randomized in accordance with their age, stage of disease, Gleason, prostate-specific antigen, and prostate volume were selected. In compliance with the results of pre-surgical examination, all the patients had low oncological risk and were not concerned in sexual function. Volume of prostate was from 22 to 65u2009cm3, prostate-specific antigen level was from 4.1 to 10u2009ng/mL, and level of neoplastic process differentiation using Gleason grading system was from 6 to 7a (3u2009+u20094) scores. Results: Patients after prostate cryoablation in early post-surgical period felt lower intensity of postoperative pain compared with those who had undergone prostatectomy. Follow-up period up to 12u2009months manifested significant true reduction of prostate-specific antigen level in both groups of patients. Frequency of stress-induced enuresis in Group 1 was not observed. Conclusion: Radical prostatectomy is still the traditional treatment of choice in the case of localized prostate cancer. But we can draw the conclusion that cryoablation is an effective low-invasive method for treatment of low oncological risk patients, which gives the opportunity both to achieve good oncological results and to preserve high life quality.

Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate

IntroductionBenign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures.AimTo determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation.Materials and methodsRetrospective study included 465 patients with bladder outlet obstruction (IPSSu2009>u200920, Qmaxu2009<u200910) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3—HoLEP; 4—ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1—HoLEP; 2—ThuFLEP). In four cases, stenting was not performed (2—HoLEP; 2—ThuFLEP). The follow-up period was 6xa0months.ResultsPostoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30xa0days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis—up to 1.5xa0cm; the calyx—up to 0.5xa0cm). At 1xa0month after surgery, no patients had dilatation of the PCS.ConclusionsUpper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.

Local anesthesia for ultrasound-guided percutaneous cryoablation of renal cell carcinoma

Background.xa0 There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation. Objective:xa0 to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control. Materials and methods.xa0 In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men – 4, women – 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 – along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided – in 4. One patient had a single kidney. At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3rdxa0generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically. Results.xa0 According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node’s formations decreased on average by 6–8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment. Conclusions.xa0 Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.

Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function

BackgroundThe impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP).MethodsWe performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS >u200920, Qmax <u200910xa0mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after.ResultsA total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (pu2009=u20090.17). At six month the IIEF-5 score was unchanged (pu2009=u20090.26 and pu2009=u20090.08) and comparable in both groups (pu2009=u20090.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (pu2009<u20090.001).ConclusionsBoth TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.

PD23-07 EFFECT OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) ON THE SEXUAL FUNCTION

IPSS, Qmax, residual volume) were recorded preoperatively and at each follow-up visit. RESULTS: Median initial prostate volume was not significantly different between the groups (LV: 44.1ml, TURP: 44.8ml; p1⁄40.47). After catheter removal, the relative prostate volume reduction (RVR) was significantly lower following LV (table). Six weeks and six months after LV RVR increased significantly (both p<0.001). However, RVR remained significantly lower after LV throughout the entire 3-year observation period (table). All clinical outcome parameters improved significantly and remained so for 3 years without relevant differences between the groups. No significant differences in overall re-treatment rates were observed (LV: 5 (5.1%), TURP: 5 (6.5%), p1⁄40.75) CONCLUSIONS: After 3 years, prostate volume reduction remained inferior after 120W greenlight LV compared to TURP. However, as yet the lower volume reduction did not translate into inferior functional outcome or higher retreatment rates. Further follow-up of our cohort will reveal if the extent of tissue ablation impacts the long-term outcome of the procedures.

Comparative analysis of the effectiveness of various techniques of endoscopic prostate enucleation in a single center

AIMnTo compare electro- and laser enucleation (thulium, holmium) of prostate hyperplasia.nnnMATERIAL AND METHODSn693 prostate hyperplasia patients were enrolled. 489 patients underwent holmium enucleation (HoLEP), 51 - monopolar enucleation, 153 - thulium enucleation (ThuLEP). Prostate volume was 91.7 (50-250) cm3. There were no significant differences in preoperative variables between both groups (I-PSS, QoL, Qmax, residual urine volume) (p>0.05).nnnRESULTSnMean time of HoLEP was 97.0±42.2 min, monopolar enucleation - 112.9±36.3 min, ThuLEP duration was significantly less (77.4±36.3 min, p<0.01). An efficacy of all methods was confirmed in 6 months after surgery by significant (p<0.01) improvement of functional parameters (I-PSS, QoL, Qmax, residual urine volume).nnnCONCLUSIONnHigh efficiency of thulium and holmium enucleation allows to consider them as gold standard of prostate hyperplasia management. Despite higher incidence of complications an efficacy of monopolar enucleation is comparable to that in laser techniques.