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MP71-14 COMPARISON OF EFFICIENCY AND COMPLICATIONS OF LUMENIS AND WOLF MORCELLATOR AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
MP71-14
Table 1: Demographic and perioperative data Variables
Mean SD / No (%)
Variables
e795
Mean SD / No (%)
COMPARISON OF EFFICIENCY AND COMPLICATIONS OF LUMENIS AND WOLF MORCELLATOR AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE
Age at time of surgery (years)
73.8 8.7 (56-93)
Weight of enucleated tissue
56.4 29.8 (17-151)
Patients with Diabetes Mellitus
14 (34.14%)
Energy utilized (KJ)
195.25 101.81
Pankaj Maheshwari*, Neeraj Shah, Reeta Maheshwari, Mumbai, India
Patients on ongoing anticoagulants
13 (31.7%)
Energy/ prostate ratio (KJ/ml)
4.3 2.4
Patients with indwelling urethral catheters
18 (43.9%)
Enucleation time (min)
87.9 35.3
Preoperative ASA score
1.26 0.55 (1-3)
Morcellation time (min)
16.4 10.1
Preoperative PSA (ng/dl)
20.6 25.7 (0.69- 162.19)
Morcellation ratio (g/min)
103 37
Preoperative IPSS
20.4 9.4
Operating time (min)
103 37
Preoperative QoL
3.8 1.5
Catheterization time
1.3 1.0
INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is now a standard option for surgical management of benign prostatic hyperplasia (BPH). While laser enucleation techniques have been widely investigated, morcellation techniques remain poorly evaluated. We retrospectively evaluated the two common morcellator devices for their in vivo safely and efficiency. METHODS: From January 2010 to September 2013, 222 patients underwent HoLEP for BEP. Of these Wolf ’Piranha’ morcellator (WM) was used in 140 patients while Lumenis ’VersaCut’ Morcellator (LM) was used in remaining 82. These patients were compared for safety parameters like incidence of bladder mucosal injury, bladder perforation, and bleeding needing electrocoagulation. The morcellation efficiency (ME) was also compared. Morcellation efficiency was defined as the ratio of weight of morcellated tissue in grams and time needed for morcellation in minutes. RESULTS: WM was found to be safer than LM in all safety parameters (Table-1). LM was more efficient. Eight patients with hard smooth rounded adenomatous nodules could not be morcellated by WM. The suction of WM had difficulty in grasping these smooth nodules. They had to be crushed by a stone grasping forceps before continuing morcellation. CONCLUSIONS: The Lumenis morcellator is faster than the Wolf morcellator. The morcellation by WM was safer than LM.
(days) Preoperative Qmax (mL/
6.4 5.0
Hospital stay (days)
1.2 0.46
sec) Preoperative PVR (mL)
371 278
Failed trial of voiding
3 (7.3 %)
Preoperative IIEF-score
0.52 2.4
Postoperative hematuria
4 (9.8%)
(conservative) Preoperative prostate size
83.4 50.0 (25-258)
by TRUS (cc) Concomitant
Transient urinary
1 (2.4%)
incontinence 4 (9.8%)
cystolithotripsy
ASA: American Society of Anesthesiologists, PSA: Prostatic specific antigen, IPSS: International prostate symptoms score, QoL: Quality of life, Qmax: Maximum flow rate, PVR: Post-void residual urine, IIEF: International index of erectile function, TRUS: Transrectal ultrasound.
Source of Funding: None
MP71-13 HOLEP IN OCTOGENARIANS: OUTCOMES AND SAFETY±± Tae Gyeong Jeon*, Chan Ho Lee, Tae Nam Kim, Dong Gil Shin, Hyun Jun Park, Hong Koo Ha, Moon Kee Chung, Jeong Zoo Lee, Busan, Korea, Republic of INTRODUCTION AND OBJECTIVES: To evaluate the efficacy and morbidity of HoLEP(Holmium laser enucleation of prostate) procedure in octogenarians with lower urinary tract symptoms (LUTs) suggestive of benign prostatic hyperplasia (BPH). METHODS: From May 2009 through May 2013, 89 octogenarians (16.5%) were described. A retrospective review using a prospectively maintained database was performed. The procedure was done by one surgeon.The preoperative and postoperative International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), Quality of Life (QOL), International Index of Erectile Function (IIEF) and postvoid residual (PVR) urine volume were obtained preoperatively, at 3 mo postoperatively. RESULTS: The mean age at time of procedure was 82.3+/2.3(80-91)years, and mean prostate volume and mean PSA were 64.6+/-36.2gm (30.5-192.0 gm) and 4.7+/-5.3ng (0.05-133 ng), respectively. Indications for surgery were urinary retension 17 cases(19.1%), LUTs with bladder stone 13 cases (14.6%) and refractory LUTs 23cases (25.8%). Operation time and enuclated tissue weight were 82.7+/-56.93(7-294) minutes and 32.23+/-29.71(1-116)gm, respectively. Preoperative and postoperative at 3 months, IPSS were 22.57+/-8.28 and 7.42+/-6.84 (p¼0.028), QoL were 4.87+/-1.11 and 1.78+/-1.55 (p<0.001), respectively. IIEF was no significant changed (p¼0.823). The mean Qmax increased from 7.59+/-4.24 to 12.98+/8.41ml/s and mean PVR decreased from 76.21+/-72.09 to 40.22+/48.86ml (p¼0.01). Postoperative complications,without any perioperative deaths, de novo urethral stricture was reported in 3 patients (3.4%), urethral soundation was done. No more surgical treatment was required. CONCLUSIONS: HoLEP is a safe and effective procedure for the treatment of symptomatic BPH, with low perioperative morbidity in old age patients. Source of Funding: none
Morcellator Number of patients Bladder mucosal injury Bladder perforation Hematuria needing electrocoagulation Weight of enucleated tissue Time for morcellation Morcellation efficiency Failed Morcellation
Wolf Morcellator 140 11 (7.85%) 0 8 (5.71%)
Lumenis Morcellators 82 23 (28%) 3 (3.66%) 11 (13.41%)
12-140 G 2 - 36 min 4.7 G/min 8 (5.71%)
14-130 G 1.5 - 22 min 8.4G/min 0
Source of Funding: None
MP71-15 EVOLUTION OF THE GREENLIGHTÔ LASER: A COMPARISON ON ENERGY UTILIZATION AND LASER TIME BETWEEN 80W KTP, 120W LBO AND 180W LBO. Helen Freeborn*, Cairns, Australia; Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: Photoselective vaporisation (PVP) of prostate is now a commonly used surgical treatment for Benign Prostatic Hypertrophy (BPH) however there is limited literature comparing the energy utilization and laser time as technology has evolved. This is the first study to compare all three consoles of the GreenLightÔ laser, 80W KTP, 120W LBO and 180W LBO in these areas. METHODS: This study was a retrospective analysis of a prospectively documented ethics approved database of a PVP procedures performed by a single surgeon in Sydney, Australia over an eight-year period. Total energy (kJ) used and laser times (minutes) were analysed in relation to type of machine used and prostate volume. The mean energy used per gram of prostate volume (as measured by transrectal ultrasound) and the mean laser time for a particular prostate gland volume were compared using the Wilcoxon Two Sample Tests to determine statistical significance. RESULTS: A total of 622 patients received PVP, with 99 receiving 80W KTP, 324 120W LBO and 199 180W LBO. The median
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
MP71-14
Table 1: Demographic and perioperative data Variables
Mean SD / No (%)
Variables
e795
Mean SD / No (%)
COMPARISON OF EFFICIENCY AND COMPLICATIONS OF LUMENIS AND WOLF MORCELLATOR AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE
Age at time of surgery (years)
73.8 8.7 (56-93)
Weight of enucleated tissue
56.4 29.8 (17-151)
Patients with Diabetes Mellitus
14 (34.14%)
Energy utilized (KJ)
195.25 101.81
Pankaj Maheshwari*, Neeraj Shah, Reeta Maheshwari, Mumbai, India
Patients on ongoing anticoagulants
13 (31.7%)
Energy/ prostate ratio (KJ/ml)
4.3 2.4
Patients with indwelling urethral catheters
18 (43.9%)
Enucleation time (min)
87.9 35.3
Preoperative ASA score
1.26 0.55 (1-3)
Morcellation time (min)
16.4 10.1
Preoperative PSA (ng/dl)
20.6 25.7 (0.69- 162.19)
Morcellation ratio (g/min)
103 37
Preoperative IPSS
20.4 9.4
Operating time (min)
103 37
Preoperative QoL
3.8 1.5
Catheterization time
1.3 1.0
INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is now a standard option for surgical management of benign prostatic hyperplasia (BPH). While laser enucleation techniques have been widely investigated, morcellation techniques remain poorly evaluated. We retrospectively evaluated the two common morcellator devices for their in vivo safely and efficiency. METHODS: From January 2010 to September 2013, 222 patients underwent HoLEP for BEP. Of these Wolf ’Piranha’ morcellator (WM) was used in 140 patients while Lumenis ’VersaCut’ Morcellator (LM) was used in remaining 82. These patients were compared for safety parameters like incidence of bladder mucosal injury, bladder perforation, and bleeding needing electrocoagulation. The morcellation efficiency (ME) was also compared. Morcellation efficiency was defined as the ratio of weight of morcellated tissue in grams and time needed for morcellation in minutes. RESULTS: WM was found to be safer than LM in all safety parameters (Table-1). LM was more efficient. Eight patients with hard smooth rounded adenomatous nodules could not be morcellated by WM. The suction of WM had difficulty in grasping these smooth nodules. They had to be crushed by a stone grasping forceps before continuing morcellation. CONCLUSIONS: The Lumenis morcellator is faster than the Wolf morcellator. The morcellation by WM was safer than LM.
(days) Preoperative Qmax (mL/
6.4 5.0
Hospital stay (days)
1.2 0.46
sec) Preoperative PVR (mL)
371 278
Failed trial of voiding
3 (7.3 %)
Preoperative IIEF-score
0.52 2.4
Postoperative hematuria
4 (9.8%)
(conservative) Preoperative prostate size
83.4 50.0 (25-258)
by TRUS (cc) Concomitant
Transient urinary
1 (2.4%)
incontinence 4 (9.8%)
cystolithotripsy
ASA: American Society of Anesthesiologists, PSA: Prostatic specific antigen, IPSS: International prostate symptoms score, QoL: Quality of life, Qmax: Maximum flow rate, PVR: Post-void residual urine, IIEF: International index of erectile function, TRUS: Transrectal ultrasound.
Source of Funding: None
MP71-13 HOLEP IN OCTOGENARIANS: OUTCOMES AND SAFETY±± Tae Gyeong Jeon*, Chan Ho Lee, Tae Nam Kim, Dong Gil Shin, Hyun Jun Park, Hong Koo Ha, Moon Kee Chung, Jeong Zoo Lee, Busan, Korea, Republic of INTRODUCTION AND OBJECTIVES: To evaluate the efficacy and morbidity of HoLEP(Holmium laser enucleation of prostate) procedure in octogenarians with lower urinary tract symptoms (LUTs) suggestive of benign prostatic hyperplasia (BPH). METHODS: From May 2009 through May 2013, 89 octogenarians (16.5%) were described. A retrospective review using a prospectively maintained database was performed. The procedure was done by one surgeon.The preoperative and postoperative International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), Quality of Life (QOL), International Index of Erectile Function (IIEF) and postvoid residual (PVR) urine volume were obtained preoperatively, at 3 mo postoperatively. RESULTS: The mean age at time of procedure was 82.3+/2.3(80-91)years, and mean prostate volume and mean PSA were 64.6+/-36.2gm (30.5-192.0 gm) and 4.7+/-5.3ng (0.05-133 ng), respectively. Indications for surgery were urinary retension 17 cases(19.1%), LUTs with bladder stone 13 cases (14.6%) and refractory LUTs 23cases (25.8%). Operation time and enuclated tissue weight were 82.7+/-56.93(7-294) minutes and 32.23+/-29.71(1-116)gm, respectively. Preoperative and postoperative at 3 months, IPSS were 22.57+/-8.28 and 7.42+/-6.84 (p¼0.028), QoL were 4.87+/-1.11 and 1.78+/-1.55 (p<0.001), respectively. IIEF was no significant changed (p¼0.823). The mean Qmax increased from 7.59+/-4.24 to 12.98+/8.41ml/s and mean PVR decreased from 76.21+/-72.09 to 40.22+/48.86ml (p¼0.01). Postoperative complications,without any perioperative deaths, de novo urethral stricture was reported in 3 patients (3.4%), urethral soundation was done. No more surgical treatment was required. CONCLUSIONS: HoLEP is a safe and effective procedure for the treatment of symptomatic BPH, with low perioperative morbidity in old age patients. Source of Funding: none
Morcellator Number of patients Bladder mucosal injury Bladder perforation Hematuria needing electrocoagulation Weight of enucleated tissue Time for morcellation Morcellation efficiency Failed Morcellation
Wolf Morcellator 140 11 (7.85%) 0 8 (5.71%)
Lumenis Morcellators 82 23 (28%) 3 (3.66%) 11 (13.41%)
12-140 G 2 - 36 min 4.7 G/min 8 (5.71%)
14-130 G 1.5 - 22 min 8.4G/min 0
Source of Funding: None
MP71-15 EVOLUTION OF THE GREENLIGHTÔ LASER: A COMPARISON ON ENERGY UTILIZATION AND LASER TIME BETWEEN 80W KTP, 120W LBO AND 180W LBO. Helen Freeborn*, Cairns, Australia; Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: Photoselective vaporisation (PVP) of prostate is now a commonly used surgical treatment for Benign Prostatic Hypertrophy (BPH) however there is limited literature comparing the energy utilization and laser time as technology has evolved. This is the first study to compare all three consoles of the GreenLightÔ laser, 80W KTP, 120W LBO and 180W LBO in these areas. METHODS: This study was a retrospective analysis of a prospectively documented ethics approved database of a PVP procedures performed by a single surgeon in Sydney, Australia over an eight-year period. Total energy (kJ) used and laser times (minutes) were analysed in relation to type of machine used and prostate volume. The mean energy used per gram of prostate volume (as measured by transrectal ultrasound) and the mean laser time for a particular prostate gland volume were compared using the Wilcoxon Two Sample Tests to determine statistical significance. RESULTS: A total of 622 patients received PVP, with 99 receiving 80W KTP, 324 120W LBO and 199 180W LBO. The median