Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology

MP11-1 - Veil sparring vs. Standard Holmium laser Enucleation of the prostate for treatment of benign prostate hyperplasia; Preliminary results of randomized clinical trial

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Post Holmium laser Enucleation of the prostate (HoLEP) transient urinary incontinence (TUI) is a frustrating postoperative event both for surgeon and patient. Stretch of the urinary sphincter and mucosal stripping off the sphincter ring are potential predisposing factors.


Methods :

Between April 2016 and January 2018, 120 patients were randomized to Veil sparring (Vs.HoLEP) and standard (St.HoLEP) with 1:1 ratio. Single surgeon performed all procedures.


St.HoLEP was classically performed as described by Elhilali group 2010.


In Vs.HoLEP; more proximal mucosal incision lateral to the veru followed by early separation of the adenoma from the sphincter ring after identification of the plane of enucleation. Eventually cutting the 12 O`clock mucosal strip proximal to the sphincter ring with progressive dissection above the adenoma starts before accomplishing the enucleation procedure.


Postoperative continence status was assessed at 1, 4 and 12 months using one-hour pad test. All baseline and perioperative parameters were depicted and compared. Functional urinary outcome measures were assessed at different follow up points and compared.


Results :

Baseline patients` demographics, prostate size and indications of intervention were comparable.


Type and grade of UI at 1, 4 and 12 months were summarized in table 1.


Significantly higher overall rate of UI was reported in St.HoLEP at 1 and 4 months respectively (P= 0.01 and 0.02).


 


In St.HoLEP high grade UI (grade II-VI) were reported significantly more than Vs.HoLEP at 1 and 4 months respectively (P=0.04 and 0.02).


 


There were no differences in the overall rate, type and grade of UI reported among evaluable patients at 12 postoperatively.


 


There was significant comparable improvement in IPSS, Q.max and PVR in both groups at different follow up points compared to preoperative values. At one year, median IPSS, Q.max and PVR were comparable in both groups (P=0.4, 0.7 and 0.09 following Vs.HoLEP and St.HoLEP respectively).


Median postoperative change in PSA was 89% (43:99) following Vs.HoLEP vs. 84% (62:94) after St.HoLEP, P=0.92.


Both groups showed comparable perioperative and late postoperative complication throughout the first year.


Conclusions :

Veil sparring HoLEP achieve less early postoperative TUI both in terms of rate of TUI and degree of TUI. However, it does not affect one-year continence outcome.

Ahmed M. Elshal

Lecturer
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Islam F. Eldiasty

specialist urologist
Mansoura urology and nephrology center
Mansoura, Ad Daqahliyah, Egypt

Hossam Nabeeh

Mansoura, Ad Daqahliyah, Egypt

Abdelwahab Hashem

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Mohamed Soltan

Mansoura, Ad Daqahliyah, Egypt

Fady K. Ghobrial

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt