Search Results (5)

In this study, AEEP (anatomical enucleation of the prostate) with a thulium laser was performed in 115 men at a single institution between January 2019 and March 2022 for surgical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) [...] Full article

The third edition of the Nursing and Pediatrics Congress was held in Paris from 16–19 June 2021, with the aim of contributing the experiences and reflections of relevant health professionals (pediatricians, pediatric surgeons, obstetricians, nurses, midwives, dieticians, and lactation consultants) to the knowledge of the most critical period of human life: its first 1000 days [...] Full article

Background: Benign prostatic hyperplasia (BPH) is commonly responsible for lower urinary tract symptoms (LUTS) in men aged 50 or over. Sexual dysfunctions, such as ejaculatory disorders (EjD), go along with LUTS but are frequently overlooked in the initial evaluation. This review aimed to detail BPH-related EjD, as well as their modifications by medical, surgical, and interventional treatments. Methods: We conducted a narrative review looking for publications between 1990 and 2020, regarding physiopathology, epidemiology, evaluation, and therapeutic management (medical, surgical, and interventional) of BPH-related EjD. Results: Sixty-five articles were included in our final analysis. Forty-six percent of men presenting with LUTS reported EjD. If the prevalence increases with age and LUTS severity, the functional impairment is not correlated with age. Several self-questionnaires evaluated the sexual function, but only four approaches are specific to EjD. Medical therapies were exposed to anejaculation, rather than retrograde ejaculation (RE) (4–30% (alpha-blockers), 4–18% (5-alpha-reductase inhibitors)). Regarding surgical therapies, trans-urethral resection of the prostate (TURP) and incision of the prostate (TUIP) are associated with 50–70% and 21–35% of RE. The RE rate is important after open simple prostatectomy but can be reduced with robotic approaches and urethral sparing techniques (19%). Anatomic endoscopic enucleation of the prostate (AEEP) with or without a laser source is associated with an 11–36% RE rate, according to supramontanal preservation. Recent surgical techniques (Rezum©, Aquablation©, or Urolift©) were developed to preserve antegrade ejaculation with promising short-term results. Regardless of the surgical approach, anatomic studies suggest that the preservation of peri-montanal tissue (7.5 mm laterally; 10 mm proximally) is primordial to avoid post-operative RE. Finally, prostate artery embolization (PAE) limits the RE rate but exposes it to a 12 months 10% re-intervention rate. Conclusion: EjD concerns almost half of the patients presenting BPH-related LUTS. Initial evaluation of EjD impairment is primordial before medical or surgical therapy. Peri-montanal tissue preservation represents a key point for antegrade ejaculation preservation, regardless of the surgical option. Full article

Objective: To compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). Methods: The national surgical quality improvement program database was queried for AEEP, RASP, and OSP procedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. Results: We identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. Conclusion: AEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP. Full article

The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise. Full article