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Top-down Holmium Laser Enucleation of the Prostate: Technical Aspects and Early Outcomes
Accepted Manuscript
Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes Hazem Elmansy , Amr Hodhod , Ahmed Kotb , Owen Prowse , Walid Shahrour PII: DOI: Reference:
S0090-4295(19)30086-X https://doi.org/10.1016/j.urology.2019.01.019 URL 21438
To appear in:
Urology
Received date: Accepted date:
11 December 2018 21 January 2019
Please cite this article as: Hazem Elmansy , Amr Hodhod , Ahmed Kotb , Owen Prowse , Walid Shahrour , Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes, Urology (2019), doi: https://doi.org/10.1016/j.urology.2019.01.019
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes Short running title: Top-Down HoLEP.
CR IP T
Author names and affiliations: Hazem Elmansy, Amr Hodhod, Ahmed Kotb, Owen Prowse, Walid Shahrour Urology department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
AN US
Keywords : Benign Prostatic Hyperplasia Holmium Laser Enucleation
ED
M
Corresponding author. Hazem Elmansy, MD, MSc, FRCSC Assistant professor, Urology, Northern Ontario School of medicine, Thunder Bay, Ontario, Canada [email protected] 146 Court Street South Thunder Bay, ON P7B 2X6 Office: (807)2859292 Fax: 1-855-893-1469
CE
PT
Conflict of interest: Hazem Elmansy: has received a speaker honorarium from Lumenis Inc Other co-authours: no conflict of intrest
AC
Acknowledgement: None
1
ACCEPTED MANUSCRIPT
Objective: To clarify the key steps and evaluate the early results of the recently introduced TopDown Holmium Laser Enucleation of the Prostate (HoLEP).1,2 This technique was developed to shorten the steep learning curve associated with the conventional approach. Patients and Methods: Sixty patients with a median age of 73 years (54-88) underwent HoLEP
CR IP T
between 2017 and 2018. The Top-Down technique was performed by one surgeon (H.E). We used a 100-W holmium: YAG Laser (VersaPulse PowerSuite, Lumenis, Yokneam, Israel) with a 550 μm laser fiber and a 28 Fr continuous flow resectoscope (Karl Storz, Germany). In this video, we clarified the stages of enucleation: posterior groove incision, 12 o’clock urethral
AN US
mucosa incision, top-down dissection (anteroposterior direction), apical tissue dissection, bladder neck dissection. We collected data related to prostate size, enucleation time, morcellation time, perioperative complications and early outcomes.
M
Results: Fifty-seven percent of patients presented with acute urine retention and the remaining had severe obstructive lower urinary tract symptoms. The median TRUS prostatic volume was
ED
124 mL (70-266). The median resected volume was 90 grams (44-242) with a median enucleation time of 92 min (42-131). At three months follow-up, we observed that the urine
PT
stream significantly improved with a median Qmax 23.6 mL/s (17-42). Two patients (3.3%) had
CE
urge incontinence, and 2 other patients (3.3%) had stress incontinence at 3 months follow-up. There were no reported intraoperative complications. We noticed that performing apical
AC
dissection from top-down resulted in easy visualization of the mucosal strip. This approach eliminates the need to encircle the mucosal strip reducing enucleation time. Conclusion: The Top-Down HoLEP technique has emerged as a novel modification to conventional HoLEP. The preliminary results are comparable to the original approach.3,4 In our
2
ACCEPTED MANUSCRIPT
opinion, the Top-Down method may reduce the complexity, operating time, and the learning
AC
CE
PT
ED
M
AN US
CR IP T
curve for urologists performing the HoLEP procedure.
3
ACCEPTED MANUSCRIPT
References 1.
Rivera ME, Lingeman JE, Krambeck AE. Holmium Laser Enucleation of the Prostate. J
Endourol 2018; 32(S1): S7-S9. 2.
Endo F, Shiga Y, Minagawa S, et al. Anteroposterior dissection HoLEP: a modification to
3.
El-Hakim A, Elhilali MM. Holmium laser enucleation of the prostate can be taught: the
first learning experience. BJU Int 2002; 90(9): 863-9.
Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate:
AN US
4.
CR IP T
prevent transient stress urinary incontinence. Urology 2010; 76(6): 1451-5.
AC
CE
PT
ED
M
modified technical aspects. BJU Int 2010; 105(5): 584-5.
4
Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes Hazem Elmansy , Amr Hodhod , Ahmed Kotb , Owen Prowse , Walid Shahrour PII: DOI: Reference:
S0090-4295(19)30086-X https://doi.org/10.1016/j.urology.2019.01.019 URL 21438
To appear in:
Urology
Received date: Accepted date:
11 December 2018 21 January 2019
Please cite this article as: Hazem Elmansy , Amr Hodhod , Ahmed Kotb , Owen Prowse , Walid Shahrour , Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes, Urology (2019), doi: https://doi.org/10.1016/j.urology.2019.01.019
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Top-Down Holmium Laser Enucleation of the Prostate: Technical aspects and early outcomes Short running title: Top-Down HoLEP.
CR IP T
Author names and affiliations: Hazem Elmansy, Amr Hodhod, Ahmed Kotb, Owen Prowse, Walid Shahrour Urology department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
AN US
Keywords : Benign Prostatic Hyperplasia Holmium Laser Enucleation
ED
M
Corresponding author. Hazem Elmansy, MD, MSc, FRCSC Assistant professor, Urology, Northern Ontario School of medicine, Thunder Bay, Ontario, Canada [email protected] 146 Court Street South Thunder Bay, ON P7B 2X6 Office: (807)2859292 Fax: 1-855-893-1469
CE
PT
Conflict of interest: Hazem Elmansy: has received a speaker honorarium from Lumenis Inc Other co-authours: no conflict of intrest
AC
Acknowledgement: None
1
ACCEPTED MANUSCRIPT
Objective: To clarify the key steps and evaluate the early results of the recently introduced TopDown Holmium Laser Enucleation of the Prostate (HoLEP).1,2 This technique was developed to shorten the steep learning curve associated with the conventional approach. Patients and Methods: Sixty patients with a median age of 73 years (54-88) underwent HoLEP
CR IP T
between 2017 and 2018. The Top-Down technique was performed by one surgeon (H.E). We used a 100-W holmium: YAG Laser (VersaPulse PowerSuite, Lumenis, Yokneam, Israel) with a 550 μm laser fiber and a 28 Fr continuous flow resectoscope (Karl Storz, Germany). In this video, we clarified the stages of enucleation: posterior groove incision, 12 o’clock urethral
AN US
mucosa incision, top-down dissection (anteroposterior direction), apical tissue dissection, bladder neck dissection. We collected data related to prostate size, enucleation time, morcellation time, perioperative complications and early outcomes.
M
Results: Fifty-seven percent of patients presented with acute urine retention and the remaining had severe obstructive lower urinary tract symptoms. The median TRUS prostatic volume was
ED
124 mL (70-266). The median resected volume was 90 grams (44-242) with a median enucleation time of 92 min (42-131). At three months follow-up, we observed that the urine
PT
stream significantly improved with a median Qmax 23.6 mL/s (17-42). Two patients (3.3%) had
CE
urge incontinence, and 2 other patients (3.3%) had stress incontinence at 3 months follow-up. There were no reported intraoperative complications. We noticed that performing apical
AC
dissection from top-down resulted in easy visualization of the mucosal strip. This approach eliminates the need to encircle the mucosal strip reducing enucleation time. Conclusion: The Top-Down HoLEP technique has emerged as a novel modification to conventional HoLEP. The preliminary results are comparable to the original approach.3,4 In our
2
ACCEPTED MANUSCRIPT
opinion, the Top-Down method may reduce the complexity, operating time, and the learning
AC
CE
PT
ED
M
AN US
CR IP T
curve for urologists performing the HoLEP procedure.
3
ACCEPTED MANUSCRIPT
References 1.
Rivera ME, Lingeman JE, Krambeck AE. Holmium Laser Enucleation of the Prostate. J
Endourol 2018; 32(S1): S7-S9. 2.
Endo F, Shiga Y, Minagawa S, et al. Anteroposterior dissection HoLEP: a modification to
3.
El-Hakim A, Elhilali MM. Holmium laser enucleation of the prostate can be taught: the
first learning experience. BJU Int 2002; 90(9): 863-9.
Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate:
AN US
4.
CR IP T
prevent transient stress urinary incontinence. Urology 2010; 76(6): 1451-5.
AC
CE
PT
ED
M
modified technical aspects. BJU Int 2010; 105(5): 584-5.
4