Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial (original) (raw)
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Holmium laser prostatic resection for patients presenting with acute urinary retention
BJU International, 2008
questionnaires aimed at determining patients' American Urologic Association Symptom Index (AUA-SI) and Quality-of-Life (QoL) scores and medication usage were also obtained. Statistical analyses were used to compare the clinical characteristics and outcomes between patients with and with no AUR for up to 2 years after HoLRP. RESULTS All patients had the catheter removed successfully by 1 month after surgery; those presenting with AUR tended to have a greater improvement in clinical outcomes than those with no AUR, including a mean AUA-SI score decrease by ≈ 13 and ≈ 8 points, and a QoL score decrease by ≈ 2 and ≈ 1.4 points, respectively. These decreases were maintained throughout the study period. Patients with AUR had significantly greater decreases in their postvoid residual urine volume than those with no AUR. Serum prostate-specific antigen levels also had a modest but sustained decrease (14%) in both groups. There were no significant decreases in the reported use of BPH-related medications after surgery in either group. CONCLUSIONS HoLRP (100 W) is a safe and effective surgical therapy for patients presenting with AUR. The present results suggest that the short-and long-term outcomes of these patients are similar between men presenting with and with no AUR.
Urodynamic assessment in the laser treatment of benign prostatic enlargement
British Journal of Urology, 1995
Objective To determine if bladder outlet obstruction can be adequately relieved after laser prostatectomy. Patients and methods Since November 1992, a total of 105 patients underwent laser treatment of the prostate because of complaints related to benign prostatic enlargement (BPE). To date, urodynamic data from a study of pressure flow analysis are available for 79 patients both at baseline and at 6 months after treatment. Patients were evaluated using changes in symptoms (IPSS symptom score), peak flow rate (Q m a x), IPSS score from 21.3 at baseline to 5.3 at the 6-month follow-up. The Qmiix improved from 7.9 mL/s to .17.8 mL/s, and the PVR decreased from 91.6 mL to 15.6 mL. At baseline, >80% of the patients were considered obstructed according to the analysis of pressure flow, whereas 6 months after laser treatment, only 5% of the patients were still considered obstructed. A com parison of the outcome between minimally obstructed patients and severely obstructed patients showed comparable improvements. post-voiding residual volume (PVR), detrusor pressure Conclusion Laser therapy of the prostate was, according to urodynamic parameters, capable of relieving outlet obstruction and minimally obstructed patients also showed a significant relief of outlet obstruction, compared to patients with severe bladder outlet Keywords Benign prostatic enlargement, urodynamics, at maximum flow (Pdet at Qmax), and the linear passive urethral resistance relation (LPURR). Moreover, patients with minimal bladder outlet obstruction were obstruction. Results There was a significant improvement in mean pressure flow analysis, bladder outlet obstruction, laser r , j tive and objective results comparable to those obtained
The Journal of …, 2005
Bladder neck incision (BNI) is a common, minimally invasive treatment option for bladder outflow obstruction in men with a small prostate. We compared BNI using the holmium: YAG laser to holmium enucleation of the prostate (HoLEP) in a prospective, randomized, urodynamically based trial. Materials and Methods: A total of 40 patients with urodynamic obstruction (Schafer grade 2 or greater) and a prostate of 40 gm or greater on transrectal ultrasound (TRUS) were randomized equally to holmium laser BNI (HoBNI) or HoLEP as an outpatient procedure. The outcomes assessed were operative time, catheter time and hospital time. American Urological Association and quality of life scores, and maximal urinary flow rates were measured at baseline, and 1, 3, 6 and 12 months postoperatively, while pressure flow studies and TRUS volume measurement were performed at baseline and 6 months. Results: The 2 groups were well matched for all variables at baseline. HoBNI was significantly more rapid to perform than HoLEP (p Ͻ0.001). Two patients (10%) in the HoBNI group required recatheterization compared with none in the HoLEP group. There was no significant difference in catheter time (22.9 vs 23.2 hours) or hospital time (12.3 vs 13.7 hours) between the groups. Five patients remained obstructed urodynamically at 6 months. All were in the HoBNI group and 4 of the 5 men had a prostate that was greater than 30 gm. Four of these patients required HoLEP for persistent lower urinary tract symptoms. In the remaining unoperated patients there were no significant differences in American Urological Association and quality of life scores or in the maximal urinary flow rate at each assessment. At 6 months detrusor pressure at maximal urinary flow was significantly lower (p Ͻ0.05) and TRUS volume was significantly smaller (p Ͻ0.001) in the HoLEP group There was significantly more early stress incontinence postoperatively in the HoLEP group but no bladder neck contractures were detected. Conclusions: Relief of obstruction was better after HoLEP and fewer patients required recatheterization or reoperation, although more reported early postoperative stress incontinence. Catheter time, hospital time and perioperative morbidity were similar. HoBNI and HoLEP are safe and feasible as outpatient procedures in patients with a small prostate but HoBNI is more rapid to perform.
2011
To prospectively compare the diagnostic accuracy of intravesical prostatic protrusion (IPP), detrusor wall thickness (DWT), prostate volume (PV) and serum prostate specific antigen (PSA) levels for detecting bladder outlet obstruction (BOO) and predicting acute urinary retention (AUR) secondary to benign prostatic obstruction. Patients and methods: In all, 135 men who presented with lower urinary tract symptoms due to benign prostatic enlargement were enrolled in the study; among them, 50 presented with AUR. Thirty normal men in the same age group were included and represented a control group for normative data. Their evaluation included a digital rectal examination, International Prostate Symptom Score and quality-of-life question, uroflowmetry and serum total PSA assay. Transabdominal ultrasonography was used to measure the PV, IPP DWT and post-void residual urine volume. Pressure-flow urodynamic studies were used as the reference standard test for BOO, differentiating obstructed from unobstructed bladders. DWT, IPP, PV and total PSA level served as index tests. To compare the usefulness