To evaluate outcomes after laser Endoscopic enucleation of the prostate (EEP) stratified by whether early apical release (EAR) was performed or not.
We retrospectively reviewed patients with clinical benign prostatic hyperplasia who underwent EEP with holmium or thulium fiber laser in 8 centers (January 2020-January 2022).
previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, concomitant lower urinary tract surgery. One-to-one propensity score-matching was performed between patients with EAR versus no EAR, with covariates including age, prostate volume, diabetes mellitus, hypertension, preoperative indwelling catheter, IPSS, Qmax, enucleation and laser types. Multivariable logistic regression analyses were performed to evaluate independent predictors of 30-day postoperative complications and urinary incontinence.
EAR was performed in 2094 of 4392 included patients. The matched cohort consisted of 787 patients per arm. Total operation time was significantly longer in the EAR group (median 75 vs 67 minutes, p=0.004). Early complications were higher in the EAR group (18.6% vs 12.5%, p=0.001), while postoperative incontinence rates were similar (14.1% vs 13.1%, p=0.61). Multivariable regression analysis showed that 3-lobe enucleation and operation time were significant predictors of postoperative complications; preoperative indwelling catheterization, higher prostate volume, and en-bloc enucleation were associated with higher odds of postoperative incontinence.
retrospective nature.
Performing EAR during EEP is associated with a greater incidence of early complications, which was mainly driven by higher rates of postoperative hematuria and perioperative transfusion. The risk of postoperative incontinence and its duration are not affected by EAR.
Urology. 2024 Mar 09 [Epub ahead of print]
Vineet Gauhar, Ee Jean Lim, Khi Yung Fong, Fernando Gómez Sancha, Moisés Rodríguez Socarrás, Dmitry Enikeev, Mario Sofer, Azimdjon N Tursunkulov, Dean Elterman, Mohammed Taif Bendigeri, Jeremy Yuen-Chun Teoh, Abhay Mahajan, Tanuj Pal Bhatia, Sorokin Nikolai Ivanovich, Nariman Gadzhiev, Lie Kwok Ying, Biligere Sarvajit, Bhaskar Kumar Somani, Thomas R W Herrmann, Daniele Castellani
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Singapore General Hospital, Singapore, Singapore., Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Rabin Medical Center, Petah Tikva, Israel., Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India., Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India., Department of Urology and Andrology, Lomonosov Moscow State University, Russian Federation., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy. Electronic address: .