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MP13-05 PREDICTORS OF REOPERATION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATE HYPERPLASIA
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
There was no significant difference between the two morcellators regarding perioperative biochemical changes and complications apart from more bladder mucosal injuries in the Versacut group (9%) and slightly more intraoperative machinary problems with Piranha morcellator. Furthermore, similar retrieved tissue weight, catheter time and hospital stay were found in the two morcellators Table1. However, less median morcellation time, need to use cold loop for removal of nonmorcellated pieces and to score the adenoma by laser for better adenoma-blade bite and higher median morcellation rate 6.2 (2.8:12) gm/ min with Piranha morcellator Table1. Among group-B, smaller prostates were allocated to Mushroom technique and mini-laparotomy was chosen for larger prostates Table 1. However, similar safety profile was found with significantly more retrieved tissue weight, extraction rate and catheterization time in mini-laparotomy group Table 1. Regardless the used approach, prostate size independently predicts hospital stay (P¼0.04). CONCLUSIONS: Morcellation with Piranha morcellator seems most efficient and safe way. However in absence of tissue morcellator, mini-laparotomy extraction of the adenoma is efficient and safe with longer catheter time and similar hospital stay. Table 1 Morcellator group (Group A)
Non-morcellator group (Group B)
Piranha
Versacut
P
Minilaparotomy
Mushroom
Number of procedures
67
55
–
15
12
–
Median, range of preoperative TRUS size of prostate (ml)
130 (59:295)
114 (46:345)
0.1
179 (137:230)
93 (64:145)
0.00
P
–
–
–
–
–
–
Bleeding necessitating post retrieval hemostasis (%) (laser/monopolar)
1 (1.4)
5 (9)
0.06
–
1
1
Median, range of Hemoglobin deficit* (g/dl)
1.2 (0.1:4.8)
1.5 (0.1:3.7)
0.2
0.3 (0.4:3.5)
0.9 (0.1:4.3)
0.6
Median, range of Hematocrit value deficit* (%)
4.3 (-1.6:14.7)
4.3 (-7.9:20.2)
0.8
4.9 (0.8:11.4)
4.9 (1.5:13.5)
0.3
Median, range of Blood sodium deficit* (m.mol/l)
1.5 (1:2.1)
3 (-8.7:11.6)
0.7
3 (1:3)
0.0 (-7:3)
0.09
^V¢ Bladder injury (%) a Bladder mucosal injury
–
5 (9)
0.01
–
1
1
4 (2.9)
2 (3.6)
0.19
–
1
1
Safety
Postoperative hematuria (%)
–
–
–
–
–
–
Extraction or Morcellation time
20 (5:30)
25 (5:70)
0.04
39 (33:45)
42 (19:95)
0.1
Histopathology; median, range of weight of specimen (gms)
67 (23:230)
62 (14:189)
0.07
115 (56:193)
38 (15:90)
0.00
^V¢ BPH (%) a
65 (97)
50 (92)
0.34
15
12
1
–
2 (3.6)
–
–
–
–
^V¢ BPH with focal a prostate cancer (%)
2 (3)
3 (4.4)
–
–
–
–
Extraction or Morcellation rate (gm/min) (Extracted weight/ Morcellation time)
6.2 (2.8:12)
2.13 (0.46:7)
0.00
4.6 (1.53:5.3)
1.09 (0.6:2.2)
0.00
Use of cold loop for extraction of nonmorcellated parts (%)
4 (5.9)
17 (30.9)
0.00
NA
NA
–
Laser scoring of the adenoma to ease bite by the blade (%)
–
7
0.00
NA
NA
–
Intraoperative machinery problems (%)
7 (10.4)
2 (3.6)
0.2
NA
NA
–
Median, range of Catheterization time (days)
1 (1:5)
1 (1:3)
0.3
5 (5:7)
2 (1:3)
0.01
Median, range of Hospital stay (days)
1 (1:3)
1 (1:4)
0.08
1 (1:4)
2 (1:3)
0.07
Efficacy
^V¢ BPH with a prostatitis (%)
* Preoperative minus immediate postoperative value, NA; not applicable
Source of Funding: none
e137
MP13-04 IS POWER EVERYTHING IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE SURGERY? THE FIRST REPORTED 50 WATT HOLMIUM LASER ENUCLEATION OF THE PROSTATE SERIES. Farooq Khan*, Mohamed Asad Saleemi, Sanjeev Taneja, Asher Alam, Luton, United Kingdom; Ian Nunney, Norwich, United Kingdom; Michal Sut, Tevita Futo ‘Aho, Cambridge, United Kingdom INTRODUCTION AND OBJECTIVES: We report a series of 50 Watt (W) holmium laser enucleation of the prostate (HoLEP) undertaken in a single institution. The aim of the study was to report outcomes across all prostate sizes during the learning curve of two surgeons to see if 50W HoLEP surgery is a viable option, both clinically and financially, for hospitals wishing to develop such a service. METHODS: Two HoLEP naïve surgeons (FAK, MAS) completed 105 HoLEPs over a 14 month period using a 50W Holmium laser (Auriga XL, StarMedTec GmbH, a Boston Scientific Company). Pre and post operative data including flow rates (Qmax), residual volume (RV), international prostate symptom scores (IPSS), quality of life scores (QoL), total surgical times, hospital stay, histology, haemoglobin (Hb), creatinine (Cr) and catheter times were accurately recorded. RESULTS: Wilcoxon non-parametric rank testing using SAS statistical software version 9.3 was used. Median patient age was 70 years, median prostate volume 50cc with a mean enucleation weight of 31.67g (range 1e105g) across the series that included 23 laser bladder neck incisions. Removing these gave a median enucleated weight of 40g. Mean hospital stay was 1.03 days with 11 cases completed as day-case surgery. Mean operating time (enucleation and morcellation) was 104.4 mins. 47 of the 105 cases were for urinary retention (45%), the remainder for symptoms and/or proven urodynamic bladder outlet obstruction. All patients were rendered catheter free with the immediate day 1 post-operative catheter-free rate of 84%. There was marked improvement in flow rates (Qmax) with median increase of 7.9mls/s (p¼000.1), IPSS median reduction of 12 points (p¼0.0001) and QoL scores by 2 (p¼0.0001). A small median decrease in Hb of 1.55g/dl (p¼0.0001) was noted, but no transfusions took place in this series and a small clinically insignificant rise in Cr of 5 mmol/l (p¼0.0002) was noted. Pre and post-operative RV remained statistically insignificant. 3 cancers were reported in our cohort. Return of the capital investment for the project was achieved by the 16th month, mainly by bed days saved (176.5) compared to our historical cohort of TURP patients, well ahead of the projected plan of 3.25 years CONCLUSIONS: Excellent patient outcomes from 50W HoLEP surgery are achievable. This can enable the delivery of a high quality HoLEP service at much reduced financial cost to hospitals wishing to offer this service compared to the current cost of 100W and 120W Holmium laser systems on the market. Source of Funding: None
MP13-05 PREDICTORS OF REOPERATION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATE HYPERPLASIA Mohamed Elkoushy*, Ahmed Elshal, Mostafa Elhilali, Montreal, Canada INTRODUCTION AND OBJECTIVES: To determine factors predicting reoperation after Holmium laser enucleation of the prostate (HoLEP) for management of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) METHODS: A prospectively maintained database was reviewed for patients undergoing HoLEP for symptomatic BPH. Baseline and follow-up data were compared in terms of International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), residual urine (PVR) and prostatic specific antigen (PSA) at 1, 6, and 12 months and then annually. Perioperative and late adverse events were recorded. Reoperation was defined as the need for any surgical intervention to relieve bothering LUTS after HoLEP. A multivariate logistic
e138
THE JOURNAL OF UROLOGYâ
regression model was used to determine possible covariates associated with reoperation and a Kaplan-Meier curve assessed the time to reoperation. RESULTS: A total of 1216 HoLEP procedures were operated between March 1998 and October 2013 with a mean prostate volume of 94.852.7cc. Catheter time and hospital stay were 1.4 1.9 and 1.3 1.6 days, respectively. After a mean follow-up of 7.3 years (1- 14 years), 52 (4.3%) patients needed reoperation for recurrent LUTS; 13 (1.07%) for recurrent adenoma, 14 (1.15%) for BNC and 25 (2.05%) for de novo urethral stricture. In multivariate regression, smaller prostate size and history of previous prostate surgery predicted recurrence of adenoma. BNC was significantly associated with smaller glands while longer operative time and postoperative catheterization were significantly associated with urethral stricture (Table 1). A Kaplan-Meier curve demonstrates freedom from post- HoLEP reoperation to be 96.9% at 5years and 95.1% at 10- years (Figure1). CONCLUSIONS: HoLEP has a long-term safety profile with low long-term complications, including reoperation rate. However, smallsize prostate may have an impact on recurrence of adenoma and bladder neck contracture. Staged procedure should be considered for exceptionally long surgery.
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
Table1 Factors affecting long-term complications after HoLEP Residual/ recurrent adenoma (n¼ 13) Variable
Bladder neck contracture (n¼ 14)
pvalue
Urethral stricture (n¼ 25)
pvalue
pvalue
Yes
No
Yes
No
yes
No
Age at surgery (years)
68.4 ^ 7.8 A
71.9 ^ A 8.1
0.10
67.2 ^ 8.4 A
72.0 ^ 8.0 A
0.02
72.6 ^ A7.6
71.9 ^ 8.1 A
0.67
Preoperative catheter (n¼452)
3 (20)
449 (37.4)
0.19
3 (21.4)
449 (37.4)
0.27
7 (28)
445 (37.4)
0.41
Previous prostate surgery (n¼85)
5 (38.5)
80 (6.5)
0.001
2 (14.3)
83 (6.9)
0.26
2 (8.0)
83 (7.0)
0.69
62.4 ^ A 21.7
94.6 ^ A 53.2
0.006
54.2 ^ A 37.7
94.6 ^ 53 A
0.004
69.2 ^ A 35.8
95.4 ^ A 53.3
0.01
Concomitant procedure (n¼117)
2 (13.3)
115 (9.6)
0.65
1 (7.1)
116 (9.6)
1.00
1 (4.0)
116 (9.7)
0.50
Operation time (min)
131 ^ A45
105 ^ 48 A
0.037
98.3 ^ A 45.4
107.7 ^ A 57.7
0.54
124.3 ^ A 46.7
103.2 ^ A 57.7
0.028
Enucleation time (min)
102.3 ^ A 45.2
90.4 ^ A 52.3
0.12
87.6 ^ A 44.2
90.7 ^ A 52.4
0.81
74.6 ^ A 45.2
91.1 ^ A 74.6
0.24
Morcellation time (min)
19.8 ^ A 12.2
17.1 ^ A 15.1
0.04
11.7 ^ 6.9 A
17.1 ^ A 15.2
0.24
11.7 ^ 5.6 A
17.2 ^ A 15.3
0.07
Total energy used (kJ)
197.4 ^ A 110.5
187 ^ A 177.6
0.82
177.9 ^ A 103.7
187.2 ^ A
0.84
168.2 ^ A 117.3
187.5 ^ A
0.59
1.4 ^ A 1.9
0.42
^ 1.4 A 1.9
^ 1.2 A 0.8
^ 1.9 A 1.2
^ 1.2 A 0.9
Prostate volume (ml)
Catheterization time (day)
^ 1.8 A 1.6
177.6 0.36
178 0.001
^ Data are reported as number (%) or mean ASD
Source of Funding: None
MP13-06 IS THE CAPSULAR PERFORATION A COMPLICATION OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)? Placer*, Carlos Salvador, David Lorente, Ana Celma, Jose pez Pacios, Jacques Planas, Enrique Trilla, Miguel Angel Lo n, Juan Morote, Barcelona, Christian Isalt, Lucas Regis, Pol Servia Spain INTRODUCTION AND OBJECTIVES: The capsule of the prostate can be injured during the performance of holmium laser enucleation of the prostate (HoLEP). It has usually been considered that the capsular lesions are more common in the early stages of the learning curve of the technique and in patients with small-sized prostates. However, the clinical significance of this lesion is unknown. Objective: To evaluate whether the presence of a capsular injury during HoLEP has any clinical relevance. METHODS: Retrospective study that evaluates whether the capsular injuries are associated with an increased morbidity or with complications. The study includes 539 consecutive patients who underwent HoLEP by a single surgeon. The patients with prostate cancer or with prior prostate surgery were excluded from the study. The clinical data were obtained prospectively. The operative results, the functional outcome, and the complications of the patients who had no capsular injuries were compared to the results of the patients who had a laceration or a perforation of the capsule. RESULTS: Of the patients, 22.8% (123/539) had a capsular injury during surgery. In 77 patients, the injury was a small tear or a minor laceration of the capsule, while in 46 patients there was an extensive perforation, through which the periprostatic fat was visible. There were no significant differences between the preoperative clinical parameters of both groups. The duration of the surgery, the amount and density of the laser energy used, and the catheter permanence time were significantly greater in the patients with capsular injuries. The risk of bladder injury during the morcellation, periprostatic extravasation of fluid, blood transfusion, or reintervention for bleeding was significantly higher in the patients with capsular injuries. The patients with capsular injuries showed greater rates of moderate to severe irritative symptoms during the first month of surgery and temporal urinary incontinence. However, there were no significant differences in the functional outcome 3 and 12 months after surgery (IPSS, QoL, IIEF-5, Qmax,
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
There was no significant difference between the two morcellators regarding perioperative biochemical changes and complications apart from more bladder mucosal injuries in the Versacut group (9%) and slightly more intraoperative machinary problems with Piranha morcellator. Furthermore, similar retrieved tissue weight, catheter time and hospital stay were found in the two morcellators Table1. However, less median morcellation time, need to use cold loop for removal of nonmorcellated pieces and to score the adenoma by laser for better adenoma-blade bite and higher median morcellation rate 6.2 (2.8:12) gm/ min with Piranha morcellator Table1. Among group-B, smaller prostates were allocated to Mushroom technique and mini-laparotomy was chosen for larger prostates Table 1. However, similar safety profile was found with significantly more retrieved tissue weight, extraction rate and catheterization time in mini-laparotomy group Table 1. Regardless the used approach, prostate size independently predicts hospital stay (P¼0.04). CONCLUSIONS: Morcellation with Piranha morcellator seems most efficient and safe way. However in absence of tissue morcellator, mini-laparotomy extraction of the adenoma is efficient and safe with longer catheter time and similar hospital stay. Table 1 Morcellator group (Group A)
Non-morcellator group (Group B)
Piranha
Versacut
P
Minilaparotomy
Mushroom
Number of procedures
67
55
–
15
12
–
Median, range of preoperative TRUS size of prostate (ml)
130 (59:295)
114 (46:345)
0.1
179 (137:230)
93 (64:145)
0.00
P
–
–
–
–
–
–
Bleeding necessitating post retrieval hemostasis (%) (laser/monopolar)
1 (1.4)
5 (9)
0.06
–
1
1
Median, range of Hemoglobin deficit* (g/dl)
1.2 (0.1:4.8)
1.5 (0.1:3.7)
0.2
0.3 (0.4:3.5)
0.9 (0.1:4.3)
0.6
Median, range of Hematocrit value deficit* (%)
4.3 (-1.6:14.7)
4.3 (-7.9:20.2)
0.8
4.9 (0.8:11.4)
4.9 (1.5:13.5)
0.3
Median, range of Blood sodium deficit* (m.mol/l)
1.5 (1:2.1)
3 (-8.7:11.6)
0.7
3 (1:3)
0.0 (-7:3)
0.09
^V¢ Bladder injury (%) a Bladder mucosal injury
–
5 (9)
0.01
–
1
1
4 (2.9)
2 (3.6)
0.19
–
1
1
Safety
Postoperative hematuria (%)
–
–
–
–
–
–
Extraction or Morcellation time
20 (5:30)
25 (5:70)
0.04
39 (33:45)
42 (19:95)
0.1
Histopathology; median, range of weight of specimen (gms)
67 (23:230)
62 (14:189)
0.07
115 (56:193)
38 (15:90)
0.00
^V¢ BPH (%) a
65 (97)
50 (92)
0.34
15
12
1
–
2 (3.6)
–
–
–
–
^V¢ BPH with focal a prostate cancer (%)
2 (3)
3 (4.4)
–
–
–
–
Extraction or Morcellation rate (gm/min) (Extracted weight/ Morcellation time)
6.2 (2.8:12)
2.13 (0.46:7)
0.00
4.6 (1.53:5.3)
1.09 (0.6:2.2)
0.00
Use of cold loop for extraction of nonmorcellated parts (%)
4 (5.9)
17 (30.9)
0.00
NA
NA
–
Laser scoring of the adenoma to ease bite by the blade (%)
–
7
0.00
NA
NA
–
Intraoperative machinery problems (%)
7 (10.4)
2 (3.6)
0.2
NA
NA
–
Median, range of Catheterization time (days)
1 (1:5)
1 (1:3)
0.3
5 (5:7)
2 (1:3)
0.01
Median, range of Hospital stay (days)
1 (1:3)
1 (1:4)
0.08
1 (1:4)
2 (1:3)
0.07
Efficacy
^V¢ BPH with a prostatitis (%)
* Preoperative minus immediate postoperative value, NA; not applicable
Source of Funding: none
e137
MP13-04 IS POWER EVERYTHING IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE SURGERY? THE FIRST REPORTED 50 WATT HOLMIUM LASER ENUCLEATION OF THE PROSTATE SERIES. Farooq Khan*, Mohamed Asad Saleemi, Sanjeev Taneja, Asher Alam, Luton, United Kingdom; Ian Nunney, Norwich, United Kingdom; Michal Sut, Tevita Futo ‘Aho, Cambridge, United Kingdom INTRODUCTION AND OBJECTIVES: We report a series of 50 Watt (W) holmium laser enucleation of the prostate (HoLEP) undertaken in a single institution. The aim of the study was to report outcomes across all prostate sizes during the learning curve of two surgeons to see if 50W HoLEP surgery is a viable option, both clinically and financially, for hospitals wishing to develop such a service. METHODS: Two HoLEP naïve surgeons (FAK, MAS) completed 105 HoLEPs over a 14 month period using a 50W Holmium laser (Auriga XL, StarMedTec GmbH, a Boston Scientific Company). Pre and post operative data including flow rates (Qmax), residual volume (RV), international prostate symptom scores (IPSS), quality of life scores (QoL), total surgical times, hospital stay, histology, haemoglobin (Hb), creatinine (Cr) and catheter times were accurately recorded. RESULTS: Wilcoxon non-parametric rank testing using SAS statistical software version 9.3 was used. Median patient age was 70 years, median prostate volume 50cc with a mean enucleation weight of 31.67g (range 1e105g) across the series that included 23 laser bladder neck incisions. Removing these gave a median enucleated weight of 40g. Mean hospital stay was 1.03 days with 11 cases completed as day-case surgery. Mean operating time (enucleation and morcellation) was 104.4 mins. 47 of the 105 cases were for urinary retention (45%), the remainder for symptoms and/or proven urodynamic bladder outlet obstruction. All patients were rendered catheter free with the immediate day 1 post-operative catheter-free rate of 84%. There was marked improvement in flow rates (Qmax) with median increase of 7.9mls/s (p¼000.1), IPSS median reduction of 12 points (p¼0.0001) and QoL scores by 2 (p¼0.0001). A small median decrease in Hb of 1.55g/dl (p¼0.0001) was noted, but no transfusions took place in this series and a small clinically insignificant rise in Cr of 5 mmol/l (p¼0.0002) was noted. Pre and post-operative RV remained statistically insignificant. 3 cancers were reported in our cohort. Return of the capital investment for the project was achieved by the 16th month, mainly by bed days saved (176.5) compared to our historical cohort of TURP patients, well ahead of the projected plan of 3.25 years CONCLUSIONS: Excellent patient outcomes from 50W HoLEP surgery are achievable. This can enable the delivery of a high quality HoLEP service at much reduced financial cost to hospitals wishing to offer this service compared to the current cost of 100W and 120W Holmium laser systems on the market. Source of Funding: None
MP13-05 PREDICTORS OF REOPERATION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATE HYPERPLASIA Mohamed Elkoushy*, Ahmed Elshal, Mostafa Elhilali, Montreal, Canada INTRODUCTION AND OBJECTIVES: To determine factors predicting reoperation after Holmium laser enucleation of the prostate (HoLEP) for management of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) METHODS: A prospectively maintained database was reviewed for patients undergoing HoLEP for symptomatic BPH. Baseline and follow-up data were compared in terms of International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), residual urine (PVR) and prostatic specific antigen (PSA) at 1, 6, and 12 months and then annually. Perioperative and late adverse events were recorded. Reoperation was defined as the need for any surgical intervention to relieve bothering LUTS after HoLEP. A multivariate logistic
e138
THE JOURNAL OF UROLOGYâ
regression model was used to determine possible covariates associated with reoperation and a Kaplan-Meier curve assessed the time to reoperation. RESULTS: A total of 1216 HoLEP procedures were operated between March 1998 and October 2013 with a mean prostate volume of 94.852.7cc. Catheter time and hospital stay were 1.4 1.9 and 1.3 1.6 days, respectively. After a mean follow-up of 7.3 years (1- 14 years), 52 (4.3%) patients needed reoperation for recurrent LUTS; 13 (1.07%) for recurrent adenoma, 14 (1.15%) for BNC and 25 (2.05%) for de novo urethral stricture. In multivariate regression, smaller prostate size and history of previous prostate surgery predicted recurrence of adenoma. BNC was significantly associated with smaller glands while longer operative time and postoperative catheterization were significantly associated with urethral stricture (Table 1). A Kaplan-Meier curve demonstrates freedom from post- HoLEP reoperation to be 96.9% at 5years and 95.1% at 10- years (Figure1). CONCLUSIONS: HoLEP has a long-term safety profile with low long-term complications, including reoperation rate. However, smallsize prostate may have an impact on recurrence of adenoma and bladder neck contracture. Staged procedure should be considered for exceptionally long surgery.
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
Table1 Factors affecting long-term complications after HoLEP Residual/ recurrent adenoma (n¼ 13) Variable
Bladder neck contracture (n¼ 14)
pvalue
Urethral stricture (n¼ 25)
pvalue
pvalue
Yes
No
Yes
No
yes
No
Age at surgery (years)
68.4 ^ 7.8 A
71.9 ^ A 8.1
0.10
67.2 ^ 8.4 A
72.0 ^ 8.0 A
0.02
72.6 ^ A7.6
71.9 ^ 8.1 A
0.67
Preoperative catheter (n¼452)
3 (20)
449 (37.4)
0.19
3 (21.4)
449 (37.4)
0.27
7 (28)
445 (37.4)
0.41
Previous prostate surgery (n¼85)
5 (38.5)
80 (6.5)
0.001
2 (14.3)
83 (6.9)
0.26
2 (8.0)
83 (7.0)
0.69
62.4 ^ A 21.7
94.6 ^ A 53.2
0.006
54.2 ^ A 37.7
94.6 ^ 53 A
0.004
69.2 ^ A 35.8
95.4 ^ A 53.3
0.01
Concomitant procedure (n¼117)
2 (13.3)
115 (9.6)
0.65
1 (7.1)
116 (9.6)
1.00
1 (4.0)
116 (9.7)
0.50
Operation time (min)
131 ^ A45
105 ^ 48 A
0.037
98.3 ^ A 45.4
107.7 ^ A 57.7
0.54
124.3 ^ A 46.7
103.2 ^ A 57.7
0.028
Enucleation time (min)
102.3 ^ A 45.2
90.4 ^ A 52.3
0.12
87.6 ^ A 44.2
90.7 ^ A 52.4
0.81
74.6 ^ A 45.2
91.1 ^ A 74.6
0.24
Morcellation time (min)
19.8 ^ A 12.2
17.1 ^ A 15.1
0.04
11.7 ^ 6.9 A
17.1 ^ A 15.2
0.24
11.7 ^ 5.6 A
17.2 ^ A 15.3
0.07
Total energy used (kJ)
197.4 ^ A 110.5
187 ^ A 177.6
0.82
177.9 ^ A 103.7
187.2 ^ A
0.84
168.2 ^ A 117.3
187.5 ^ A
0.59
1.4 ^ A 1.9
0.42
^ 1.4 A 1.9
^ 1.2 A 0.8
^ 1.9 A 1.2
^ 1.2 A 0.9
Prostate volume (ml)
Catheterization time (day)
^ 1.8 A 1.6
177.6 0.36
178 0.001
^ Data are reported as number (%) or mean ASD
Source of Funding: None
MP13-06 IS THE CAPSULAR PERFORATION A COMPLICATION OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)? Placer*, Carlos Salvador, David Lorente, Ana Celma, Jose pez Pacios, Jacques Planas, Enrique Trilla, Miguel Angel Lo n, Juan Morote, Barcelona, Christian Isalt, Lucas Regis, Pol Servia Spain INTRODUCTION AND OBJECTIVES: The capsule of the prostate can be injured during the performance of holmium laser enucleation of the prostate (HoLEP). It has usually been considered that the capsular lesions are more common in the early stages of the learning curve of the technique and in patients with small-sized prostates. However, the clinical significance of this lesion is unknown. Objective: To evaluate whether the presence of a capsular injury during HoLEP has any clinical relevance. METHODS: Retrospective study that evaluates whether the capsular injuries are associated with an increased morbidity or with complications. The study includes 539 consecutive patients who underwent HoLEP by a single surgeon. The patients with prostate cancer or with prior prostate surgery were excluded from the study. The clinical data were obtained prospectively. The operative results, the functional outcome, and the complications of the patients who had no capsular injuries were compared to the results of the patients who had a laceration or a perforation of the capsule. RESULTS: Of the patients, 22.8% (123/539) had a capsular injury during surgery. In 77 patients, the injury was a small tear or a minor laceration of the capsule, while in 46 patients there was an extensive perforation, through which the periprostatic fat was visible. There were no significant differences between the preoperative clinical parameters of both groups. The duration of the surgery, the amount and density of the laser energy used, and the catheter permanence time were significantly greater in the patients with capsular injuries. The risk of bladder injury during the morcellation, periprostatic extravasation of fluid, blood transfusion, or reintervention for bleeding was significantly higher in the patients with capsular injuries. The patients with capsular injuries showed greater rates of moderate to severe irritative symptoms during the first month of surgery and temporal urinary incontinence. However, there were no significant differences in the functional outcome 3 and 12 months after surgery (IPSS, QoL, IIEF-5, Qmax,