- Email: [email protected]
2177 LEARNING CURVE IN THULIUM ENUCLEATION OF THE PROSTATE
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
THE JOURNAL OF UROLOGY姞
e893
with large prostates. Despite a not deniable risk for bleeding complications, the associated treatment morbidity seems decisively lower in comparison to open simple prostatectomy even if the learning curve is included. Source of Funding: None
2177 LEARNING CURVE IN THULIUM ENUCLEATION OF THE PROSTATE Patrick Krombach*, Manuel Ritter, Axel Häcker, Mannheim, Germany INTRODUCTION AND OBJECTIVES: Thulium laser enucleation of the prostate employs the same technical steps as holmium laserenucleation of the prostate. the learning curve for HoLEP is reported to be around 50 cases. The thulium laser offers the possibility to vaporize tissue. In the very beginning of the learning curve this presumably results in a higher vaporization gradient (Joules used/gram resected tissue). To evaluate the learning curve of thulium laserenucleation of the prostate, the intraoperative date from a single novice surgeon was analyzed retrospectively. METHODS: Intraoperative data from the first 105 consecutive cases of thulium Laserenucleation (Revolix®, Lisa Laser, Germany) and subsequent morcellation (Piranha®, Richard Wolf, Germany) were analyzed. For all procedures an experienced surgeon was present for back-up. The novice surgeon had no TUR-experience, he assisted in approximately 50 cases prior to his own procedures. Total OR-time (min.), laser time (min.), praeoperative TRUS volumetry (g), histology weight (g) and laser energy delivered (Joule) were assessed. The median values of consecutive groups of 10 cases were compared: gram/OR time, gram/laser time, Joule/gram. RESULTS: As shown in the graphics, the amount of resected tissue per total OR-time increases. After the first 50 procedures the values increased from less than 0,6g/min to more than 0,6g/min. A steady curve for the vaporization gradient seems to appear after 50 cases. This reflects more uniform movements of the surgeon within the surgical layers. Intraoperative bleedings which required vaporisation appeared constantly without notable relation to the learning curve. CONCLUSIONS: A novice surgeon needs approx. 50 cases to develop stable enucleation skills with the thulium laser.
Source of Funding: None
2178 SAFETY AND EFFECTIVENESS OF THULIUM VAPOENUCLEATION OF THE PROSTATE IN PATIENTS WITH ONGOING ORAL ANTICOAGULATION Christopher Netsch*, Hamburg, Germany; Michael Stöhrer, Hannover, Germany; Sophie Knipper, Thorsten Bach, Hamburg, Germany; Thomas Herrmann, Hannover, Germany; Andreas Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: We evaluated the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) in patients with ongoing oral anticoagulation (OA) and symptomatic benign prostatic obstruction (BPO). METHODS: Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated prospectively from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a mean American Society of Anesthesiology score of 2.7⫾0.5. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and 12-month follow-up data were analyzed. The complications were assessed. RESULTS: Mean prostate volume was 57.15⫾30.75 cc and resected tissue weight was 37.72⫾22.91 gm. The mean operative time was 74.92⫾46.81 minutes and the catheter time 2.14⫾0.36 days, respectively. The mean postoperative haemoglobin decrease was 1.4⫾1.18 g/dL. There were no perioperative thromboembolic events. Five (8.9%) patients required a second-look operation in the immediate postoperative course (haemorrhage n⫽4, residual adenoma n⫽1) and four (7.1%) patients received blood transfusions. Complications within 30 days included urinary tract infection (n⫽1, 1.7%), acute urinary retention (n⫽2, 3.6%), and delayed bleeding (n⫽4, 7.1%). These complications were managed conservatively. At 12-month follow-up, Quality of Life (4.38⫾0.93 vs. 1.47⫾0.95), international prostate symptom score (20.25⫾5.25 vs. 5.29⫾3.28), maximum urinary flow rate (8.22⫾3.15 vs. 29.4⫾11.08 ml/s), and post-void residual urine (123.6⫾98.67 vs. 22.4⫾25.35 ml) improved significantly (p⬍0.002). None of the patients were re-treated during follow-up for recurrent prostatic tissue, urethral strictures or bladder neck contractures. CONCLUSIONS: ThuVEP is a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk with ongoing OA. Source of Funding: None
2179 THE ASSOCIATION OF PROSTATE SIZE AND PERIOPERATIVE MORBIDITY IN THULIUM VAPOENUCLEATION OF THE PROSTATE Christopher Netsch*, Jasmin Hölzel, Thorsten Bach, Sophie Knipper, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: Perioperative morbidity is closely related to prostate size in transurethral resection of the
THE JOURNAL OF UROLOGY姞
e893
with large prostates. Despite a not deniable risk for bleeding complications, the associated treatment morbidity seems decisively lower in comparison to open simple prostatectomy even if the learning curve is included. Source of Funding: None
2177 LEARNING CURVE IN THULIUM ENUCLEATION OF THE PROSTATE Patrick Krombach*, Manuel Ritter, Axel Häcker, Mannheim, Germany INTRODUCTION AND OBJECTIVES: Thulium laser enucleation of the prostate employs the same technical steps as holmium laserenucleation of the prostate. the learning curve for HoLEP is reported to be around 50 cases. The thulium laser offers the possibility to vaporize tissue. In the very beginning of the learning curve this presumably results in a higher vaporization gradient (Joules used/gram resected tissue). To evaluate the learning curve of thulium laserenucleation of the prostate, the intraoperative date from a single novice surgeon was analyzed retrospectively. METHODS: Intraoperative data from the first 105 consecutive cases of thulium Laserenucleation (Revolix®, Lisa Laser, Germany) and subsequent morcellation (Piranha®, Richard Wolf, Germany) were analyzed. For all procedures an experienced surgeon was present for back-up. The novice surgeon had no TUR-experience, he assisted in approximately 50 cases prior to his own procedures. Total OR-time (min.), laser time (min.), praeoperative TRUS volumetry (g), histology weight (g) and laser energy delivered (Joule) were assessed. The median values of consecutive groups of 10 cases were compared: gram/OR time, gram/laser time, Joule/gram. RESULTS: As shown in the graphics, the amount of resected tissue per total OR-time increases. After the first 50 procedures the values increased from less than 0,6g/min to more than 0,6g/min. A steady curve for the vaporization gradient seems to appear after 50 cases. This reflects more uniform movements of the surgeon within the surgical layers. Intraoperative bleedings which required vaporisation appeared constantly without notable relation to the learning curve. CONCLUSIONS: A novice surgeon needs approx. 50 cases to develop stable enucleation skills with the thulium laser.
Source of Funding: None
2178 SAFETY AND EFFECTIVENESS OF THULIUM VAPOENUCLEATION OF THE PROSTATE IN PATIENTS WITH ONGOING ORAL ANTICOAGULATION Christopher Netsch*, Hamburg, Germany; Michael Stöhrer, Hannover, Germany; Sophie Knipper, Thorsten Bach, Hamburg, Germany; Thomas Herrmann, Hannover, Germany; Andreas Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: We evaluated the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) in patients with ongoing oral anticoagulation (OA) and symptomatic benign prostatic obstruction (BPO). METHODS: Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated prospectively from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a mean American Society of Anesthesiology score of 2.7⫾0.5. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and 12-month follow-up data were analyzed. The complications were assessed. RESULTS: Mean prostate volume was 57.15⫾30.75 cc and resected tissue weight was 37.72⫾22.91 gm. The mean operative time was 74.92⫾46.81 minutes and the catheter time 2.14⫾0.36 days, respectively. The mean postoperative haemoglobin decrease was 1.4⫾1.18 g/dL. There were no perioperative thromboembolic events. Five (8.9%) patients required a second-look operation in the immediate postoperative course (haemorrhage n⫽4, residual adenoma n⫽1) and four (7.1%) patients received blood transfusions. Complications within 30 days included urinary tract infection (n⫽1, 1.7%), acute urinary retention (n⫽2, 3.6%), and delayed bleeding (n⫽4, 7.1%). These complications were managed conservatively. At 12-month follow-up, Quality of Life (4.38⫾0.93 vs. 1.47⫾0.95), international prostate symptom score (20.25⫾5.25 vs. 5.29⫾3.28), maximum urinary flow rate (8.22⫾3.15 vs. 29.4⫾11.08 ml/s), and post-void residual urine (123.6⫾98.67 vs. 22.4⫾25.35 ml) improved significantly (p⬍0.002). None of the patients were re-treated during follow-up for recurrent prostatic tissue, urethral strictures or bladder neck contractures. CONCLUSIONS: ThuVEP is a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk with ongoing OA. Source of Funding: None
2179 THE ASSOCIATION OF PROSTATE SIZE AND PERIOPERATIVE MORBIDITY IN THULIUM VAPOENUCLEATION OF THE PROSTATE Christopher Netsch*, Jasmin Hölzel, Thorsten Bach, Sophie Knipper, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: Perioperative morbidity is closely related to prostate size in transurethral resection of the