| Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. | |
| | |
MedLine Citation:
|
PMID: 19394500 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: To analyze the self-learning curve of a single surgeon with holmium laser enucleation of the prostate and to evaluate the safety, effectiveness, and outcome of the procedure after 2 years of experience. METHODS: The data from the first 125 patients who underwent holmium laser enucleation of the prostate were retrospectively analyzed. The patients were assessed preoperatively and at 1, 3, 12, and 24 months postoperatively. The patient evaluations included serum prostate-specific antigen measurement, peak urinary flow rate determination, postvoid residual volume measurement, and symptom scores. To assess the effect of the learning curve on the perioperative data and complications, the patients were divided into subgroups of 25 consecutive patients. RESULTS: The mean patient age was 71.4 years. The average prostate volume was 75.8 mL, and the mean weight of the enucleated tissue was 46.7 g. The average operative time was 109.8 minutes. The operative times and enucleation and morcellation efficiency rates improved significantly during the learning process. The mean hemoglobin loss was 1.7 g/dL. The median catheter time and hospital stay was 44 and 30 hours, respectively. Compared with baseline, at 1 year postoperatively, the median postvoid residual urine volume had declined by 99 mL, the mean peak urinary flow rate had increased by 19 mL/s, and the mean American Urological Association symptom score had decreased by 16.5 points. All changes observed were significant and regardless of the prostate size. Persistent stress urinary incontinence (4.8%) occurred with the first enucleations of large-size prostates. Other complications included bladder neck contracture (4%) in small-size prostates and bulbar urethra stricture (1.6%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, reproducible and effective surgical modality. Case selection is necessary to avoid the morbidity associated with the first stages of the self-taught learning curve, mainly urinary incontinence. |
| | |
Authors:
|
José Placer; Antoni Gelabert-Mas; Felip Vallmanya; Josep M Manresa; Violeta Menéndez; Ramón Cortadellas; Octavio Arango |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Urology Volume: 73 ISSN: 1527-9995 ISO Abbreviation: Urology Publication Date: 2009 May |
Date Detail:
|
Created Date: 2009-04-27 Completed Date: 2009-06-04 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0366151 Medline TA: Urology Country: United States |
Other Details:
|
Languages: eng Pagination: 1042-8 Citation Subset: IM |
Affiliation:
|
Servei d'Urologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. jplacersantos@gmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aged, 80 and over Clinical Competence* Cohort Studies Humans Laser Therapy / adverse effects, methods* Lasers, Solid-State Learning Male Middle Aged Physician's Practice Patterns Prostatic Hyperplasia / complications, diagnosis, surgery* Retrospective Studies Risk Assessment Severity of Illness Index Surgical Procedures, Minimally Invasive / adverse effects, methods Treatment Outcome Urinary Bladder Neck Obstruction / etiology*, surgery* |
| Comments/Corrections | |
Comment In:
|
Urology. 2009 May;73(5):1048-9; author reply 1049
[PMID:
19394501
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three...
Next Document: Effect of nicardipine on renal function after robot-assisted laparoscopic radical prostatectomy.