Transurethral thulium laser vapoenucleation of prostate – a good alternative for open surgery

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Treatment of huge benign prostatic hyperplasia (BPH) consists an actual problem for urological community. Nowadays, open surgery is one of the basic surgical methods in treatment of large BPH, but it is less used due to the modern laser techniques. Spreading of laser surgery offers some new opprotunities for its treatment. Safety of Thulium:YAG laser in transurethral vapoenucleation of the prostate in combination with its efficiency assure a good alternative for clasic open surgery in BPH treatment.Aim of the study. Comparative assessment of the efficacy of transurethral Thulium:YAG laser vapoenucleation of prostate (ThuVEP). Materials and methods. 37 patients with average age of 67 years underwent surgical treatment of large BPH at the Department of urology and surgical nephrology, State University of Medicine and Pharmacy “Nicolae Testemițanu”. Patients were divided into two treatment groups: ThuVEP (17 patients) and open simple prostatectomy (Fuller-Freyer procedure) (20 patients) and evaluated postoperatively at 3 months. Hemoglobin drop was also evaluated at the first postoperative day. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: Prostate Volume ≥80cm3 , IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml / s. Results. Average duration of intervention: 79 min vs 63 min. The prostate volume decreased postoperative on average from 82,2 cm3 to 31,3 cm3 vs 83,4 cm3 to 31,9 cm3 , there was an increase of average Qmax from 8,2 to 20.3 ml / s vs 8,4 to 21,1 ml / s, and a decrease in mean IPSS from 19,3 to 5.3 vs 20,1 to 5,4, and PVR diminished from 67.2 ml to 15,4 ml versus 68,1 to 17,4 ml, respectively. The period of transitional macrohematuria was 2,1 days vs 5,3 days respectively. The duration of cateterization was 2,3 days in the first group and 8,3 days in the second group. Mean hemoglobin drop was 2,1g/l in Group 1 vs 3,4g/l in Group 2. Conclusions. ThuVEP is an effective alternative method in the treatment of large BPH. Immediate postoperative results of ThuVEP are similar to the results in open simple prostatectomy (Fuller-Freyer procedure). It is to mention a high safety profile characteristic for ThuVEP and a reduced hemoglobin drop comparatively to clasic open surgery

Early outcomes of transurethral thulium laser vapoenucleation of prostate

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Surgical treatment of large benign prostatic hyperplasia (BPH) remain an important problem in endourology. Open surgical procedures are still used to treat pacients with BPH. Surgical trauma and numerous contraindications make it useless in many pacients with comorbydities. A small number of endourologic procedures offer the posibility to treat large BPH. Thus, laser surgery seems to be a salvage treatment for pacients with contrindications for classical open surgery. Aim of the study. The efficiency assesment of transurethral Thulium YAG laser vapoenucleation of prostate (ThuVEP). Materials and methods.. 16 patients with average age of 71 years underwent surgical treatment of large BPH. All of them underwent ThuVEP. A 550 micron end fire laser fiber was used during vapoenucleation. 80W power setings were used in all of the pacients. The period of surveillance was of 6 months. Preoperative investigations: PSA, IPSS, QoL, TRUS-P withPVR and Qmax. Patients inclusion criteria: Prostate Volume ≥80cm3, IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4. Results. Average duration of intervention: 76 min. The prostate volume decreased postoperative on average from 83,2 cm3 to 35,4 cm3, there was an increase of average Qmax from 8,2 to 19.3 ml/s, a decrease in mean IPSS from 21,3 to 7,1, and PVR diminished from 69,1 ml to 16,1 ml. The period of transitional macrohematuria was 2,1 days. The duration of cateterization was 2,5 and mean hemoglobin drop was 2,1 g/l. Conclusions. ThuVEP is an effective method for endourologic treatment of large BPH. Immediate postoperative results of ThuVEP are promising. It is to mention a high haemorrage safe features of ThuVEP

Contemporary surgical options in large benign prostatic hyperplasia treatment

Abstract Introduction. Specialists are currently interested in the method of choice for surgical treatment in patients with enlarged benign prostate hyperplasia (> 80 cm3 ). The introduction of laser and bipolar technologies for benign prostate hyperplasia surgery has allowed effective treatment regardless of the size of the prostate gland. Material and methods. During 2020-2021, 65 patients underwent surgical treatment for large benign prostate hyperplasia. Depending on the type of surgical treatment performed, 3 study groups were identified: 22 patients underwent transurethral Thulium: YAG laser prostate vapoenucleation; 21 patients underwent transurethral bipolar prostate enucleation; and 21 patients underwent a simple prostatectomy. All patients were examined before and after surgery (at 3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score, prostate-specific antigen assessment, transrectal prostate ultrasound examination, and uroflowmetry to assess residual urine volume. Postoperative complications were recorded in accordance with the 2004 Clavien-Dindo classification. Results. There was a significant difference in the mean operative time ranging from 72±19 min (ThuVEP group) vs. 56±10 min (SP group) and 70±15 min (TUEB group), as well as a decrease in hemoglobin levels, viz. 1.2±0.4 g/dl vs. 2.6±1.1 g/dl vs. 1.6±0.5 g/dl (ThuVEP vs. SP vs. TUEB). The catheterization lasted for 2±1 days (ThuVEP) vs. 10±1 days (SP) vs. 3±1 days (TUEB). A significant improvement in Qmax was registered in the ThuVEP group (122.9%) and in the TUEB group (111.7%). However, patients after a simple prostatectomy showed an increase in Qmax of only 94%. The PVR values were reported to be the same. ThuVEP is an effective surgical technique for large BPH patients. The reduced trauma and lower complication rate of ThuVEP, as well as its effectiveness, have confirmed the need for widespread implementation of minimally invasive laser interventions

Transurethral en bloc resection of urinary bladder tumors vs conventional transurethral resection of bladder tumors. Early postoperative outcomes

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Treatment of urinary bladder tumors (UBT) remains an important problem in oncourology. Currently, transurethral resection of urinary bladder (TUR-V) remains the gold standard in the endourologic treatment of UBT. In the last decade many alternative endourologic techniques have been proposed for the treatment of UBT. Aim of the study. Comparative assessment of the efficacy of transurethral En Bloc resection of urinary bladder tumors. Materials and methods. In the period between 08.2017 – 12.2017, 25 patients with average age of 57 years underwent endourological treatment of UBT at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy. Patients were divided into two treatment groups: first group - transurethral En Bloc resection of UBT (8 patients), second group – TUR-V of UBT (17 patients). All patients were evaluated after 3 months by cystoscopy whit narrow band imaging (NBI). Results. Average duration of intervention: 39 min vs 33 min. The rate of transitional haematuria and postoperative infections was similar. During NBI cystoscopy tumor recurrence was determined in 3 cases in TUR-V group, and no recurrences in En Bloc resection group. In the En Bloc resection group additional tumors with different localization were found during NBI cystoscopy. Conclusions. Transurethral En Bloc resection of UBT is an effective method in the treatment of UBT. Results of treatment using En Bloc resection are better that conventional TUR-V of bladder tumor. Another advantage of transurethral En Bloc resection of UBT is a better staging of tumor process due to the resection of all urinary bladder wall layers which is very important to determine postoperative tactics

Transurethral Thulium laser resection of prostate vs monopolar transurethral resection – evaluation of postoperative outcomes

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Treatment of benign prostatic hyperplasia (BPH) remains one of the actual problems in endourology. Currently, monopolar TUR-P remains the gold standard in the surgical treatment of BPH. Nowadays laser technologies offer safe and efficient alternatives in BPH endourologic treatment. Aim of the study. Comparative assessment of the efficacy of transurethral Thulium laser resection of prostate. Materials and methods. In the period of 08.2017 – 02.2018, 52 patients with average age of 62 years underwent endourologic treatment of BPH at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy. Patients were divided into two treatment groups: transurethral Thulium resection of prostate (24 patients) and monopolar TUR-P (28 patients), and evaluated postoperatively after 1 month. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: prostate volume 40 - 70cm3, IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml/s. Results. Average duration of intervention: 63 min vs 47 min. The prostate volume decreased postoperatively on average from 58.4 cm3 to 26.1 cm3, vs 61.1 cm3 to 24.6 cm3, there was an increase of average Qmax from 7.3 to 20.7 ml/s vs 7,5 to 21.2 ml/s, a decrease in mean IPSS from 20.3 to 4.3 vs 21 to 4.5, and a PVR decrease from 65.2 ml to 15.5 ml vs 68.6 to 16.8 ml, respectively. The period of transitional macrohaematuria was 1.2 days vs 2.3 days respectively. The duration of catheterization was 1.5 days in the first group and 2.6 days in the second group. The complication rate was similar. Conclusions. Transurethral Thulium laser resection of prostate is an effective alternative method in the treatment of BPH. Immediate postoperative results of Thulium laser prostate resection are similar to the results of the “gold standard” – monopolar TUR-P group. The high safety profile characteristic for Thulium laser resection of prostate is also to be mentioned

Thulium: yttrium-aluminium-garnet laser transurethral vapoenucleation – a new standard in the surgical treatment of large benign prostatic hyperplasia

Introduction. According to the current recommendations of the European Association of Urology and the International Society of Urology, open simple prostatectomy is the reference standard in the surgical treatment of benign prostatic hyperplasia of large size (>80 ml). Extended trauma and a high complication rate reduce the chances to use this method. In this context, several minimally invasive laser surgical treatment techniques have been proposed in order to provide an optimal treatment to patients. Transurethral endoscopic vapoenucleation of the prostate using laser energy is a new concept in endourological surgery. Material and methods. Between September 2019 and December 2019, 93 patients with benign prostatic hyperplasia underwent surgical treatment. Two surgical methods were applied: transurethral Thulium:YAG laser prostate vapoenucleation (45 patients) and open simple prostatectomy (48 patients). All patients were evaluated preoperatively and postoperatively (3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score and International Erectile Function Index, physical examination and digital rectal examination, prostate specific antigen assessment, transrectal prostate ultrasound examination and assessment of residual urine volume, uroflowmetry. Postoperative complications were recorded according to the Clavien-Dindo classification, 2004. The inclusion criteria were total prostate volume ≥80 cm3, age ≤80 years, residual urine volume ≥70 ml, Qmax ≤10 ml/s. Results. Transurethral Thulium:YAG laser vaponucleation of prostate has proven a high surgical efficiency level. The baseline urodynamic and ultrasonographic indicators after transurethral vapoenucleation at 6 months postoperatively were similar to those in the control group (open simple prostatectomy). The duration of recovery of patients after classical surgery was significantly longer. At the same time, the rate of postoperative complications after prostate vapoenucleation was lower. Patients in the ThuVEP group did not require blood transfusions. Conclusions. According to obtained results, we can assume that transurethral vapoenucleation of the prostate with laser energy will soon become a new „gold standard” in the surgical treatment of large benign prostate hyperplasia

Comparative analysis between En-bloc resection and transurethral resection of non-muscular-invasive bladder tumors

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaAbstract. Background: Transurethral resection of the bladder (TURB) tumor was first described by Stern and McCarthy in 1931, and is still considered the gold standard in diagnosis and treatment of non-muscle-invasive bladder cancer. The quality of TURB affects accuracy of histopathologic evaluation, and subsequently impacts the risk of recurrence and patient outcome. New methods that aim to improve the effectiveness of TURB are reviewed, and recent studies are discussed, including resection methods and image enhancement techniques. Material and methods: Between January 2016 and April 2019, within the Urology Clinic of Nicolae Testemitanu State University of Medicine and Pharmacy 108 patients were surgically treated with bladder tumor pathology. Patients were divided in two groups: En-bloc resection group which includes 51 patients and transurethral resection group with 57 patients, the obtained data were comparatively analyzed. Results: Tumor analysis showed that the majority of the patients’ tumors were localized on lateral urinary bladder walls, single bladder tumors were detected in 64 (59%) cases, tumor sizes up to 3 cm were detected in 74 (69%) patients included in the study. Detrusor muscles were detected in 49 (96%) cases of En-bloc group and 45 (79%) cases of TURB group. Most recurrences occurred in patients with high-grade histological result, recurrence rate in En-bloc group occurred in 18% and in TURB group in 37%. Conclusions: The En-bloc resection technique of non-muscle-invasive bladder tumor proved to be a safe and effective method compared to the conventional transurethral resection technique (TURB). This method provides more favorable results for obtaining better quality tumor samples (present of detrusor muscle) that allow to establish correct diagnosis and staging of the disease and reduces the number of recurrences

Computerized tomography in the diagnosis of lumbar incisional hernia

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Incisional lumbar hernia is still a diagnosis problem of the first magnitude. The diagnosis of incisional hernias outside the midline remains a challenging procedure. Lumbar hernias occur in the region of the flank bounded by the 12th rib, the iliac crest, and the erector spinae and external oblique muscles. CT portrays shows the anatomic relationships in this region so well and it may be the only radiographic procedure necessary to make the diagnosis of a lumbar incisional hernia. Aim of the study. Objective evaluation of the alterations in body image and configuration of patients who underwent urological surgery via a flank incision. Materials and methods. Eligible for study were 7 patients who underwent urological surgery via lumbar incision for renal diseases. Preoperative and postoperative abdominal computerized tomography were used for evaluation. We evaluated the objective results using computerized tomography. Results. Over a 12-month period, lumbar hernias were detected with CT in seven patients, all had flank incisions, six of them with detectable flank bulge and one without. In 3 patients diffuse and large hernias were found, in two patients superiorly located hernias, which are immediately palpable below the 12th rib and subsequently thought to originate from the superior lumbar triangle, and in two patients inferiorly located hernias palpable just above the iliac crest and subsequently thought to originate from the inferior lumbar triangle. The mean age was 58 years (range 30-76); five women and two men. Of these, two were asymptomatic and five were symptomatic. All seven lumbar hernias detected on CT were on the left side. Two of them contained extraperitoneal fat and five contained bowel (descending colon or sigmoid colon). Six of the postincisional hernias showed disruption of normal muscle layers. In one case only the external oblique muscles were intact. In a high postincisional hernia there was a disruption of the intercostal muscles. Conclusions. CT can be helpful in the assessment of symptomatic patients after flank incision, to differentiate postincisional muscular weakness and intercostal neuralgia from a lumbar hernia and is able to delineate muscular and fascial layers, a defect in one or more of these layers, and the presence of herniated fat and/or viscera. Computerized tomography is the diagnostic method of choice and is recommended in all patients with a bulge after a flank incision

Este oare infecția SARS-CoV-2 cauza ulcerațiilor vezicii urinare?

Department of Urology and Surgical Nephrology, Nicolae Testemitanu SUMPhBackground. During the COVID-19 pandemic, a series of unknown pathologies of the urinary tract appeared, inclusive the modifications of the urothelium of the urinary bladder. Evidence has recently emerged that the lower urinary tract is a potential target for SARS-CoV-2 infection. Objective of the study. Elucidation of the cause of bladder ulceration in patients with COVID-19. Material and Methods. Analysis of literature review of patients with urinary tract lesions and experience in the Department of urology of the USMF, which included the evaluation of 5 patients with lower urinary tract symptoms and developed encrusted ulcerative lesions of the urinary tract, possibly secondary to SARS-Cov-2 infection. Results. All examined patients had severe form of COVID-19 and presented lower urinary tract symptom and ulcerative lesions of urinary bladder detected on USG, CT, cystoscopy. Endoscopic treatment with resection was performed. According to the literature, the presentation of urinary tract symptoms can be determined by the presence of the ACE2 receptor in urothelial cells, found in 2.4% or caused by increased inflammatory cytokines that are released into the urine and/or expressed in the bladder. Conclusion. Patients who supported severe forms of COVID-19 with lower urinary tract symptoms and prolonged urinary catheterization during the course of the disease require specialized urological management, endoscopic and litholytic treatment.Introducere. În cadrul pandemiei cu infecția COVID-19 au apărut o serie de patologii ale tractului urinar necunoscute sau puțin elucidate, inclusiv la nivelul uroteliului vezicii urinare. Recent, au apărut dovezi că tractul urinar inferior este o țintă potențială pentru infecția cu SARS-CoV-2. Scopul lucrării. Evaluarea cauzelor ulcerațiilor vezicale, la pacienții care au suportat COVID-19. Material și Metode. Analiza datelor din literatura de specialitate a pacienților cu leziuni ale vezicii urinare și a experienței propriei clinici de Urologie a USMF „Nicolae Testemițanu”, care a inclus evaluarea a 5 pacienți cu simptome ale tractului urinar inferior și au dezvoltat leziuni ulcerative încrustate ale vezicii urinare, posibil secundar infecției SARS-Cov-2. Rezultate. Toți pacienții examinați au prezentat simptome ale tractului urinar inferior și leziuni ulcerative încrustate ale vezicii urinare vizibile la examen USG, CT și cistoscopie. Pacienții au suportat forma gravă de COVID-19. S-a efectuat tratament endoscopic cu rezecția încrustărilor. Conform datelor de literatură, apariția simptomelor urinare pot fi cauzate de prezența receptorului ACE2 în celulele uroteliale, depistate în 2,4% sau de citokine inflamatorii crescute, care sunt eliberate în urină și / sau exprimate în vezica urinară. Concluzii. Pacienții care au suportat forme grave de COVID-19, cu simptomele tractului urinar inferior si cateterizare urinară prelungită în cursul bolii, necesită management urologic specializat, tratament endoscopic și litolitic

Laser Но-YAG versus transurethral incision of prostate (ITUP) in treatment of prostate sclerosis areas after chronic prostatitis

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Nowadays, patients suffering from the sclerosis of prostate became a global health problem. The main trigger factor is the presence of chronic prostatitis. This is a consequence of the inflammatory process in prostate, with structure damage tissue. Finally the damaged areas are substituted with fibrous tissue, causing developing of sclerosis in prostate. The surgical treatment of prostate sclerosis should have maximal excision of prostate tissue and minimally temperature impact on surrounding tissue. Aim of the study. Evaluation of the efficiency Но-YAG laser versus ITUP incision in treatment of prostate sclerosis after chronic prostatitis. Materials and methods.. The 46 of patients were selected with the defined diagnosis with sclerosis of prostate after chronic prostatitis during the period from 2018 till 2019. The study was conducted in the Department of urology and surgical nephrology of the State University of Medicine and Pharmacy "Nicolae Testemitanu", within the Republican Clinical Hospital "Timofei Mosneaga". The patients were divided into 2 groups depending on the method of treatment: a control group consisted of 23 patients who underwent ITUP incision and a main group 23 patients were conducted using incision with Но-YAG laser . Results. Surgical treatment was successfully performed for all cases. There were no major intra- or after surgery complications. During all procedures, blood loss was insignificant and no patient required blood transfusions. Also, there were no cases of urinary tract infection, sepsis, bleeding or urinary retention. All patients were able to void spontaneously and was no detected urinary retention or incontinence after catheter removal. Four patients were presenting moderate irritative symptoms (dysuria, hesitance and frequency) and were treated conservatively, with no further complications. In all prostate cancer cases, the pathological specimens were negative for malignancy. The mean operating time was 20 minutes (range 15 to 35 minutes), the duration of catheterization period was 48 hours (range 24 to 72 hours) and the mean hospital stay was 72 hours. Preoperative and at 1, 3 and 6 months after surgery, the mean values for Qmax, were 6.2 ml/s, 15.9 ml/s, 15.8 ml/s and 15.4 ml/s, respectively. Conclusions. The results clearly demonstrate the advantages of using laser energy for treatment of prostate sclerosis compared to ITUP, with significant increase in scores on the IPSS and QoL, maximum urinary flow rate, and a decrease in residual urine volume and frequency of relapses in the group carried out the laser dissection of prostate sclerosis