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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...

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Autores principales: Ding, Mingxia, Wang, Jiansong, Zuo, Yigang, Chen, Jian, Wang, Haifeng, Li, Ning, Liu, Jingyu, Wang, Wei, Li, Haihao
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
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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.
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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
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