A Novel Technique of Morcellation Using a Pneumovesicum After Holmium Laser Enucleation of the Prostate in Complicated Situations: Our Initial Experience and Tips
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum (PNV) after Holmium laser enucleation of the prostate (HoLEP). Methods: From January 2016 to April 2018, a total of 93 consecutive patients treated with HoLEP were enrolled in this study. For tissue morcellation, we used the PNV morcellation technique for an initial series of 21 patients and the conventional technique (Lumenis VersaCut) for a consecutive series of 72 patients. We compared efficiency and safety between the novel technique and the traditional technique. Subgroup analysis was performed to assess the effectiveness of the current technique in the large prostate (>70 mL). Results: There were significant differences in mean age and prostate volume between the 2 groups. However, there were no significant differences in the baseline characteristics and preoperative parameters in the subgroup analysis of large prostates (>70 mL). The mean morcellation efficiency was higher (8.50±1.94 minutes vs. 1.76±0.45 minutes, P<0.05) and the time of morcellation (7.81±1.25 minutes vs. 34.04±11.14 minutes, P<0.05) was shorter in the PNV group. Moreover, there were no significant differences between groups in hospitalization period (2.62±1.10 days vs. 2.90±1.26 days, P=0.852) and any other postoperative events, including recatheterization, reoperation, clot retention, and urethral stricture (P-value range, 0.194– 0.447). In the PNV group, there were some cases of procedure-related complications, including postoperative extravesical leakage (5th case), clot retention (8th case), and recatheterization (9th case). Conclusions: This method has a higher tissue retrieval efficacy, with the advantage of excellent visibility compared to conventional morcellation. The current method can be applied when a transurethral morcellator is out of order or cannot be used.
Abstract
Purpose: To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum (PNV) after Holmium laser enucleation of the prostate (HoLEP). Methods: From January 2016 to April 2018, a total of 93 consecutive patients treated with HoLEP were enrolled in this study. For tissue morcellation, we used the PNV morcellation technique for an initial series of 21 patients and the conventional technique (Lumenis VersaCut) for a consecutive series of 72 patients. We compared efficiency and safety between the novel technique and the traditional technique. Subgroup analysis was performed to assess the effectiveness of the current technique in the large prostate (>70 mL). Results: There were significant differences in mean age and prostate volume between the 2 groups. However, there were no significant differences in the baseline characteristics and preoperative parameters in the subgroup analysis of large prostates (>70 mL). The mean morcellation efficiency was higher (8.50±1.94 minutes vs. 1.76±0.45 minutes, P<0.05) and the time of morcellation (7.81±1.25 minutes vs. 34.04±11.14 minutes, P<0.05) was shorter in the PNV group. Moreover, there were no significant differences between groups in hospitalization period (2.62±1.10 days vs. 2.90±1.26 days, P=0.852) and any other postoperative events, including recatheterization, reoperation, clot retention, and urethral stricture (P-value range, 0.194– 0.447). In the PNV group, there were some cases of procedure-related complications, including postoperative extravesical leakage (5th case), clot retention (8th case), and recatheterization (9th case). Conclusions: This method has a higher tissue retrieval efficacy, with the advantage of excellent visibility compared to conventional morcellation. The current method can be applied when a transurethral morcellator is out of order or cannot be used.
참고문헌 (20)
- Gilling PJ, "Combination holmium and Nd : YAG laser ablation of the prostate : initial clinical experience", J Endourol, 9, pp.151~153 (1995)
- Kuntz RM, "Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100grams : 5-year follow-up results of a randomised clinical trial", Eur Urol, 53, pp.160~166 (2008)
- 배정범, "Holmium Laser Enucleation of Prostate for Benign Prostatic Hyperplasia: Seoul National University Hospital Experience", International Neurourology Journal, 15(1), pp.29~34 (2011), 대한배뇨장애요실금학회
- Elshal AM, "Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate(HoLEP) : assessment of two morcellators and review of literature", Can Urol Assoc J, 9, pp.E618~25 (2015)
- Shah HN, "Peri-operative complications of holmium laser enucleation of the prostate : experience in the first 280 patients, and a review of literature", BJU Int, 100, pp.94~101 (2007)
- Su Hyung Lee, "Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results", Investigative and Clinical Urology, 53(11), pp.779~784 (2012), 대한비뇨의학회
- Kuo HC, "Bladder base", trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics, 2011, pp.30, 1242~1248
- Kang J, "Laparoscopic repair of a vesicosigmoid fistula secondary to Holmium laser enucleation of the prostate(HoLEP)", Urol Case Rep, 13, pp.22~23 (2017)
- El Tayeb MM, "Wolf Piranha Versus Lumenis VersaCut prostate morcellation devices : a prospective randomized trial", J Urol, 195, pp.413~417 (2016)
- 김명, "Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia", Investigative and Clinical Urology, 54(9), pp.570~579 (2013), 대한비뇨의학회
- McAdams S, "Morcellation efficiency in Holmium laser enucleation of the prostate : oscillating morcellator outperforms reciprocating morcellator with no apparent learning curve", Urology, 106, pp.173~177 (2017)
- Peyronnet B, "Learning curves and perioperative outcomes after endoscopic enucleation of the prostate : a comparison between GreenLight 532-nm and holmium lasers", World J Urol, 35, pp.973~983 (2017)
- Humphreys MR, "Holmium laser enucleation of the prostate--outcomes independent of prostate size?", J Urol, 180, pp.2431~2435 (2008)
- Chen Q, "An improved morcellation procedure for holmium laser enucleation of the prostate", J Endourol, 26, pp.1625~1628 (2012)
- Monn MF, "Predictors of enucleation and morcellation time during Holmium laser enucleation of the prostate", Urology, 86, pp.338~342 (2015)
- 태범식, "Laparoscopic Approach for Intravesical Surgery Using Pneumovesicum in Urology: Literature Review", International Neurourology Journal, 22, pp.10~22 (2018), 대한배뇨장애요실금학회
- Choi H, "Laparoscopic single port cystolithotomy using pneumovesicum", Int Braz J Urol, 42, pp.1047~1048 (2016)
- Przudzik M, "Transvesical laparoendoscopic single-site surgery(T-LESS)to remove an unusual foreign body from the bladder", Cent European J Urol, 69, pp.312~ (2016)
- Ko YH, "Removal of long, complex foreign bodies from bladder using single laparoscopic port under pneumovesicum", J Laparoendosc Adv Surg Tech A, 20, pp.639~642 (2010)
- Asimakopoulos AD, "Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease", Surg Endosc, 29, pp.236~244 (2015)