Cargando…
AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence
OBJECTIVE: To improve HoLEP surgical techniques of finding envelope, enucleation, hemostatic and comminution, and to treate the incontinence reason predictably, so as to reduce the complications of HoLEP surgery. METHODS: Technical improvements were performed in 272 patients who underwent HoLEP duri...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708830/ http://dx.doi.org/10.3978/j.issn.2223-4683.2015.s051 |
_version_ | 1782409555170295808 |
---|---|
author | Ding, Mingxia Wang, Jiansong Zuo, Yigang Chen, Jian Wang, Haifeng Li, Ning Liu, Jingyu Wang, Wei Li, Haihao |
author_facet | Ding, Mingxia Wang, Jiansong Zuo, Yigang Chen, Jian Wang, Haifeng Li, Ning Liu, Jingyu Wang, Wei Li, Haihao |
author_sort | Ding, Mingxia |
collection | PubMed |
description | OBJECTIVE: To improve HoLEP surgical techniques of finding envelope, enucleation, hemostatic and comminution, and to treate the incontinence reason predictably, so as to reduce the complications of HoLEP surgery. METHODS: Technical improvements were performed in 272 patients who underwent HoLEP during January 2014 to December 2014. (I) The gland was enucleated in three lobes, not overall enucleation; (II) start with both sides of verumontanum to find envelope, the ‘three-lobe’ technique involves 5- and 7-o'clock position incisions with enucleation of the middle lobe and subsequent enucleation of one lateral lobe followed by the other lateral lobe; (III) we only lift the glands gently by lens body, using holmium laser blasting to peel glands, and abandon conventional mirror peeling method; (IV) if bleeding is encountered, the laser fibre can be defocused slightly from the bleeding point to achieve haemostasis; (V) we crushed glands vacantly with the status of bladder filling. The reason why postoperative urinary incontinence occurs may be thermal burns sphincter, mucosal retention inadequate, sphincter weiss at around 12:00, and sphincter injury caused by mirror body elevation, etc. Some precautions during the operation were as follows: (I) reducing laser ablation; (II) separation off the reserved side lobe mucosa before peeling; (III) avoid 12:00 distal mucosal tear; (IV) using blasting holmium laser energy not lens body to peel glands, which can avoid sphincter injury by mirror body elevation force. RESULTS: We identified 272 patients who underwent HoLEP. The median volume of enucleated adenomas was 92±24 g. The median IPSS before surgery was 23.3±6.1. Average (range) operation time was 86±21 minutes. Amount of bleeding was 56±14 mL. Postoperative patients of hospital stay was 32±5 h, average time of indwelling catheter time was 22±6 h. Patients were followed up for 6-28 months’ time, an average of 12.4 months. Postoperative patients with international prostate symptom score progressive declined. The quality of life score was 6.7±2.6. The maximum urinary flow rate also improved (P<0.05). Postoperative complication included urge urinary incontinence (36 cases, 13.2%), 31 of which did not occur in the first 5 days, 2 of which lasted for 2 days. However, there was no real urinary incontinence case. CONCLUSIONS: By improving HoLEP technology and treating the incontinence reason predictably, HoLEP proved to be a safe and effective therapy, with fewer surgical complications, and it may be potential to become a new gold standard for treating BPH. |
format | Online Article Text |
id | pubmed-4708830 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-47088302016-01-26 AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence Ding, Mingxia Wang, Jiansong Zuo, Yigang Chen, Jian Wang, Haifeng Li, Ning Liu, Jingyu Wang, Wei Li, Haihao Transl Androl Urol Podium Lecture OBJECTIVE: To improve HoLEP surgical techniques of finding envelope, enucleation, hemostatic and comminution, and to treate the incontinence reason predictably, so as to reduce the complications of HoLEP surgery. METHODS: Technical improvements were performed in 272 patients who underwent HoLEP during January 2014 to December 2014. (I) The gland was enucleated in three lobes, not overall enucleation; (II) start with both sides of verumontanum to find envelope, the ‘three-lobe’ technique involves 5- and 7-o'clock position incisions with enucleation of the middle lobe and subsequent enucleation of one lateral lobe followed by the other lateral lobe; (III) we only lift the glands gently by lens body, using holmium laser blasting to peel glands, and abandon conventional mirror peeling method; (IV) if bleeding is encountered, the laser fibre can be defocused slightly from the bleeding point to achieve haemostasis; (V) we crushed glands vacantly with the status of bladder filling. The reason why postoperative urinary incontinence occurs may be thermal burns sphincter, mucosal retention inadequate, sphincter weiss at around 12:00, and sphincter injury caused by mirror body elevation, etc. Some precautions during the operation were as follows: (I) reducing laser ablation; (II) separation off the reserved side lobe mucosa before peeling; (III) avoid 12:00 distal mucosal tear; (IV) using blasting holmium laser energy not lens body to peel glands, which can avoid sphincter injury by mirror body elevation force. RESULTS: We identified 272 patients who underwent HoLEP. The median volume of enucleated adenomas was 92±24 g. The median IPSS before surgery was 23.3±6.1. Average (range) operation time was 86±21 minutes. Amount of bleeding was 56±14 mL. Postoperative patients of hospital stay was 32±5 h, average time of indwelling catheter time was 22±6 h. Patients were followed up for 6-28 months’ time, an average of 12.4 months. Postoperative patients with international prostate symptom score progressive declined. The quality of life score was 6.7±2.6. The maximum urinary flow rate also improved (P<0.05). Postoperative complication included urge urinary incontinence (36 cases, 13.2%), 31 of which did not occur in the first 5 days, 2 of which lasted for 2 days. However, there was no real urinary incontinence case. CONCLUSIONS: By improving HoLEP technology and treating the incontinence reason predictably, HoLEP proved to be a safe and effective therapy, with fewer surgical complications, and it may be potential to become a new gold standard for treating BPH. AME Publishing Company 2015-08 /pmc/articles/PMC4708830/ http://dx.doi.org/10.3978/j.issn.2223-4683.2015.s051 Text en 2015 Translational Andrology and Urology. All rights reserved. |
spellingShingle | Podium Lecture Ding, Mingxia Wang, Jiansong Zuo, Yigang Chen, Jian Wang, Haifeng Li, Ning Liu, Jingyu Wang, Wei Li, Haihao AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title | AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title_full | AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title_fullStr | AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title_full_unstemmed | AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title_short | AB051. Technical improvement of HoLEP and prevention strategies of postoperative incontinence |
title_sort | ab051. technical improvement of holep and prevention strategies of postoperative incontinence |
topic | Podium Lecture |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708830/ http://dx.doi.org/10.3978/j.issn.2223-4683.2015.s051 |
work_keys_str_mv | AT dingmingxia ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT wangjiansong ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT zuoyigang ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT chenjian ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT wanghaifeng ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT lining ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT liujingyu ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT wangwei ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence AT lihaihao ab051technicalimprovementofholepandpreventionstrategiesofpostoperativeincontinence |