Page 20 - CUA 2020_BPH

Moderated Posters 7: BPH

MP-7.7. Table 1 (cont’d). Patient demographics position, a top-down lateral lobe dissection was performed and extended
anteroposteriorly, towards the apical adenoma at the 6 o’clock position.
Operative characteristics (cont’d) As the apical dissection was performed from top-down, the mucosal strip
Parameters Median (interquartile was easily visualized on the medial side of the scope. By incising the
range) or mean ± SD or band-shaped mucosa close to the adenoma, the apex of the adenoma was
number (percentage) completely released without damaging the ring formed by the sphincter
muscle. We recorded patients’ demographics, intraoperative, and post-
Foley catheterization duration (days) 1 (1–2) operative data. The preoperative and postoperative International Prostate
0 99 (3.4%) Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate
1 1749 (60.6%) (Qmax), and post-void residual (PVR) were evaluated.
2 602 (20.9%) Results: The median prostatic volume was 92 cc (80–150) and the median
3 250 (8.7%) age at surgery was 63.4 years. There were no intraoperative complica-
4–44 187 (6,5%) tions or blood transfusions. All patients had their catheters removed the
Required re-catheterization 170 (5.9%) next day postoperatively. Only two patients (10%) had failed a trial of
voiding (TOV) initially but succeeded after three days. The one-month
Adenocarcinoma on pathology 17 (1.9%) postoperative data are presented in Table 1.
30-day readmission 209 (13.2%) Conclusions: Top-down GreenLEP is a feasible procedure. Early outcomes
Postoperative complications (≤30 days) are satisfactory and promising. To better evaluate this technique, further
studies with larger populations and longer followup are required.
Parameters Number of patients (%)
Minor MP-7.9
Fever 63 (4.0%) Does the complexity affect the outcome of top-down holmium
UTI 126 (5.4%) laser enucleation of prostate (top-down HoLEP)? 1
Amr Hodhod , Fabiola Oquendo , Loay Abbas , Brianna Beaudry , Ahmed
1
1
1
LUTS 522 (22.3%) Kotb , Owen Prowse , Walid Shahrour , Hazem Elmansy 1
1
1
1
OAB 7 (1.1%) 1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON,
Incontinence 244 (10.4%) Canada
Introduction: In this study, we evaluated the outcome of top-down hol-
Retention 173 (7.4%) mium laser enucleation of prostate (HoLEP) for complex cases due to
Hematuria 232 (9.9%) repeated transurethral resection of the prostate (TURP) and prostate can-
Major cer, in comparison to non-complex prostates.
Methods: We retrospectively reviewed the charts of prospectively col-
Urosepsis 5 (0.8%) lected patients who underwent top-down HoLEP, by a single urologist
Osteitis Pubis 1 (0.2%) (HE), between 2017 and 2018. We used a 100-W holmium:YAG laser
®
Retrograde ejaculation 35 (4.4%) (VersaPulse PowerSuite, Lumenis) with a 550 μm laser fiber and a 28 Fr
continuous flow resectoscope. Enucleated tissue was morcellated using
Paraphymosis 1 (0.2%) a Karl Storz DrillCut Morcellator. We recorded the enucleation time,
TM
Prostatic capsule perforation 8 (0.5%) the morcellation time, and intraoperative and postoperative complica-
Postoperative transfusion 21 (1.3%) tions. All patients were followed up postoperatively at three, six, and
12 months. The evaluation included the International Prostate Symptom
Stenosis (urethra, meatus, bladder 2 (0.1%) Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax),
neck) and post-void residual (PVR).
False passage 1 (0,2%) Results: Sixty patients were enrolled in this study. The complex group
consisted of 27 patients, while the control group included 33 patients.
Arrhythmia 6 (0.4%) Patients’ characteristics are shown in Table 1. The complexity of HoLEP
Major cardiac event 12 (0.8%) was due to recurrent TURP (24 patients) and prostate cancer (three
Respiratory distress (desaturation) 3 (0.2%) patients). The mean enucleation time for the complex group was 102.1
minutes (42–131), and 80.8 minutes (45–128) for the control group
Death 4 (0.3%) (p=0.04). There was no significant difference between both groups in
terms of morcellation time, resected weight, catheter duration, and hos-
MP-7.8 pital stay. One patient in the control group had a slight bladder mucosal
Top-down Greenlight laser enucleation of the prostate injury. The postoperative outcomes regarding IPSS, QoL, Qmax, and PVR
(GreenLEP): Early results were comparable between both groups (Table 2). At one-year followup,
Fabiola Oquendo , Amr Hodhod , Loay Abbas , Brianna Beaudry , Ahmed one patient in the complex group had stress incontinence (p=0.26) and
1
1
1
1
Kotb , Owen Prowse , Walid Shahrour , Hazem Elmansy 1 one patient in each group experienced urge incontinence (p=0.89).
1
1
1
1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Conclusions: Apart from a significantly longer enucleation time in the
Canada complex group, the safety and postoperative outcomes of top-down
Introduction: Laser prostatectomy is considered one of the best modali- HoLEP were similar for both groups.
ties for the surgical management of benign prostatic hyperplasia (BPH).
Recently, the top-down technique was introduced as a modification to MP-7.10
traditional holmium laser enucleation (HoLEP). Herein, we describe the Effect of holmium laser enucleation of the prostate on prostate-
top-down technique using Greenlight laser technology and its feasibility. specific antigen kinetics in patients with prostate cancer on
Methods: Between 2018 and 2019, we prospectively collected the data active surveillance
of 20 patients who underwent Greenlight enucleation of the prostate Ahmed Ibrahim , Ahmed Zakaria , Mélanie Aube-Peterkin , Simon
1
1
1
using the top-down technique (top-down GreenLEP). A Greenlight XPS Tanguay , Serge Carrier , Armen-G. Aprikian 1
1
1
machine and a 2090 laser fibre were used for these procedures. One 1 Urology, McGill University, Montreal, QC, Canada
posterior groove was created at either 5 or 7 o’clock up to the verumon- Introduction: Our aim was to evaluate the effect of holmium laser enucle-
tanum allowing enucleation of the median lobe with the attached lateral ation of the prostate (HoLEP) on prostate-specific antigen (PSA) kinetics
lobe. After the anterior commissure mucosa was incised at the 12 o’clock for prostate cancer (PCa) patients actively managed by observation.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S121