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Archivio Italiano Di Urologia,... Feb 2024The aim of the present, retrospective study was to describe our initial experience and early outcomes of Thulium Fiber Laser enucleation of the prostate (ThuFLEP) with...
PURPOSE
The aim of the present, retrospective study was to describe our initial experience and early outcomes of Thulium Fiber Laser enucleation of the prostate (ThuFLEP) with the use of the FiberDust™ (Quanta System, Samarate, Italy) in patients with benign prostate hyperplasia.
METHODS
From June 2022 to April 2023, all patients who underwent endoscopic enucleation of the prostate at Urology Department of the University Hospital of Patras were included. A single surgeon utilizing the same standardized operative technique performed all the surgeries. The primary endpoints included the uneventful completion of the operation, the surgical time and any minor or major complication observed intra- or post-operatively.
RESULTS
Twenty patients with benign prostate hyperplasia were treated with ThuFLEP. All the surgeries were completed successfully and uneventfully. The enucleation phase of the operation was completed in a mean time of 45±9.1 min, while the average time needed for the morcellation was 17.65±3.42 min. No significant complications were observed intra- or post-operatively. The average hemoglobin drop was calculated to be 0.94±0.71 g/dL.
CONCLUSIONS
All the operations were successfully and efficiently completed with the use of the FiberDust™ (Quanta System, Samarate, Italy) in ThuFLEP. Significant blood loss or major complications were not observed.
Topics: Male; Humans; Prostate; Retrospective Studies; Thulium; Hyperplasia; Treatment Outcome; Lasers, Solid-State; Prostatic Hyperplasia; Transurethral Resection of Prostate; Laser Therapy
PubMed: 38363229
DOI: 10.4081/aiua.2024.12228 -
Fertility and Sterility Jun 2024
Comparative Study
Topics: Humans; Female; Hysteroscopy; Morcellation; Vacuum Curettage; Uterine Neoplasms; Pregnancy; Treatment Outcome; Leiomyoma
PubMed: 38346550
DOI: 10.1016/j.fertnstert.2024.02.009 -
European Journal of Obstetrics,... Mar 2024This study aimed to comprehensively evaluate the complications associated with morcellation in Total Laparoscopic Hysterectomy (TLH) procedures, providing evidence-based... (Review)
Review
OBJECTIVE
This study aimed to comprehensively evaluate the complications associated with morcellation in Total Laparoscopic Hysterectomy (TLH) procedures, providing evidence-based insights to enhance patient safety and surgical efficacy.
DATA SOURCES
A comprehensive literature search was conducted using multiple databases, including PubMed, EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials. The inclusion criteria were Studies that focused on morcellation and morcellation-related complications were included. The risk of bias in the included studies was assessed using established evaluation scales.
METHODS OF STUDY SELECTION
Thirteen studies investigating complications associated with morcellation in TLH (Total Laparoscopic Hysterectomy) were included in this review.This review covers intraoperative blood loss, length of hospital stay, loss of bag integrity, mean uterine specimen and weight, morcellation time, operation time, and TLH morcellation complications.
TABULATION, INTEGRATION, AND RESULTS
The selected studies covered different approaches and aspects related to this procedure, providing valuable insights into the factors associated with complications and efficacy of the technique in various clinical settings.This review highlights the importance of evaluating and considering complications associated with morcellation in TLH.
CONCLUSION
The findings of this review provide valuable insights into complications associated with morcellation in TLH. Clinicians could use this information to make informed decisions, implement safe protocols, and improve patient care. Addressing these complications will enhance the safety and efficacy of morcellation for TLH. Ethical Compliance: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Topics: Female; Humans; Morcellation; Laparoscopy; Hysterectomy; Uterus; Uterine Myomectomy; Uterine Neoplasms
PubMed: 38301502
DOI: 10.1016/j.ejogrb.2024.01.031 -
Asian Journal of Andrology Jan 2024We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques...
Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients.
We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
PubMed: 38265232
DOI: 10.4103/aja202375 -
Journal of Zoo and Wildlife Medicine :... Jan 2024A 36-yr-old female intact hybrid orangutan ( sp.) presented with evidence of chronic bacterial cystitis with no response to treatment with multiple systemic antibiotics....
A 36-yr-old female intact hybrid orangutan ( sp.) presented with evidence of chronic bacterial cystitis with no response to treatment with multiple systemic antibiotics. Abnormalities were identified within the reproductive tract on CT scan, and hysteroscopy was pursued based on the recommendation of an obstetrician-gynecologist. Hysteroscopic examination revealed a large amount of intrauterine foreign material consistent with wood wool from the orangutan's bedding. A hysteroscopic morcellator (MyoSure) was used to remove the foreign material. Histologic examination of endometrial biopsies showed severe suppurative to pyogranulomatous endometritis with intralesional foreign (wood) fibers and bacteria. The orangutan was treated with antibiotics, but evidence of bacterial cystitis persisted. After 15 wk, additional wood wool was identified within the uterus by hysteroscopic examination and was removed similarly. Five months later, there was no recurrence of foreign material on hysteroscopy or CT. This report describes the first documentation of intrauterine foreign material in a nonhuman primate. Hysteroscopic morcellation is a useful technique for noninvasive removal of intrauterine foreign material in great apes.
Topics: Female; Animals; Pongo; Morcellation; Pongo pygmaeus; Uterus; Anti-Bacterial Agents; Cystitis; Foreign Bodies
PubMed: 38252015
DOI: 10.1638/2023-0004 -
Cureus Dec 2023This study is a retrospective review of data from patients who were incidentally diagnosed with endometrial stromal sarcoma after a routine hysterectomy for uterine...
This study is a retrospective review of data from patients who were incidentally diagnosed with endometrial stromal sarcoma after a routine hysterectomy for uterine fibroid at the Department of Gynaecologic Oncology in a tertiary care hospital. The Institutional Review Board (IRB) gave its clearance for this study before it was carried out. Informed written consent was obtained from all patients. In our case series, the three patients presented with complaints of menorrhagia, lower abdominal pain, intermenstrual bleeding, and acute retention of urine. After the patients underwent a clinical examination and radiological scan, the diagnosis of fibroids was made. They underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histology revealed low-grade endometrial stromal sarcoma (LGESS). The patients were observed for adjuvant therapy. The patients had a follow-up period of 18-24 months. In LGESS, which is rare, prompt management is of utmost importance, because the tumour's stage is the most significant predictor of the prognosis. As there are no clear indications to suggest the presence of LGESS prior to the histopathology of the specimen, it is necessary to analyze the data of patients who are diagnosed with LGESS, in order to investigate and manage the condition more appropriately. After myomectomy for a suspected leiomyoma, there is a 0.2% chance of the result showing endometrial stromal sarcoma.
PubMed: 38229799
DOI: 10.7759/cureus.50676 -
International Journal of Biological... Feb 2024Nanofibers for drug delivery systems have gained much attention during the past years. This paper describes for the first time the loading of a bioactive precipitate...
Electrospun polydioxanone/fucoidan blend nanofibers loaded with anti-cancer precipitate from Jaspis diastra and paclitaxel: Physico-chemical characterization and in-vitro screening.
Nanofibers for drug delivery systems have gained much attention during the past years. This paper describes for the first time the loading of a bioactive precipitate (JAD) from the marine sponge Jaspis diastra in PDX and fucoidan-PDX. JAD was characterized by LC-MS/MS and the major component was jaspamide (1) with a purity of 62.66 %. The cytotoxicity of JAD was compared with paclitaxel (PTX). JAD and PTX displayed IC values of 1.10 ± 0.7 μg/mL and 0.21 ± 0.12 μg/mL on skin fibroblasts L929 cells whilst their IC values on uveal MP41 cancer cells, were 2.10 ± 0.55 μg/mL and 1.38 ± 0.68 μg/mL, respectively. JAD was found to be less cytotoxic to healthy fibroblasts compared to PTX. JAD and PTX loaded scaffolds showed sustained release over 96 h in physiological medium which is likely to reduce the secondary cytotoxic effect induced by JAD and PTX alone. The physico-chemical properties of the loaded and unloaded scaffolds together with their degradation and action on tumor microenvironment by using L929 and MP41 cells were investigated. JAD and PTX at a concentration of 0.5 % (drug/polymer, w/w) in the electrospun mats prevented growth and proliferation of L929 and MP41 cells. Co-culture of L929 and MP41 showed that the JAD and PTX loaded mats inhibited the growth of both cells and caused cell death.
Topics: Animals; Paclitaxel; Polydioxanone; Nanofibers; Chromatography, Liquid; Tandem Mass Spectrometry; Antineoplastic Agents; Neoplasms; Porifera; Cell Line, Tumor; Tumor Microenvironment; Polysaccharides
PubMed: 38185297
DOI: 10.1016/j.ijbiomac.2024.129218 -
IJU Case Reports Jan 2024Prostatic urethral lift is a treatment option for benign prostatic hyperplasia, yet information on surgeries following this procedure is scarce.
INTRODUCTION
Prostatic urethral lift is a treatment option for benign prostatic hyperplasia, yet information on surgeries following this procedure is scarce.
CASE PRESENTATION
A 71-year-old man with persistent urinary retention following prostatic urethral lift underwent a secondary holmium laser enucleation of the prostate. The morcellation procedure, complicated by the presence of implants from the previous surgery, broke the morcellator blade. The fragmented blade was successfully retrieved without any organ damage. Postoperatively, the patient encountered no complications and showed improvement in his urinary symptoms.
CONCLUSION
This case highlights the potential risk of device breakage when a secondary surgery, specifically the morcellation process, is performed following prostatic urethral lift. Care must be taken to prevent interaction between the implants and the morcellator. Our case demonstrates the efficacy of holmium laser enucleation of the prostate as a salvage surgical intervention for patients in whom prostatic urethral lift has failed.
PubMed: 38173454
DOI: 10.1002/iju5.12661 -
European Journal of Surgical Oncology :... Feb 2024Uterine sarcomas are rare tumors with a poor prognosis. Their diagnosis is often incidental, following surgery. Our goal was to examine the early management strategies...
Impact of guideline adherence and expert center referral on the early management and outcomes of uterine sarcoma patients: A retrospective analysis from the French NETSARC network.
OBJECTIVE
Uterine sarcomas are rare tumors with a poor prognosis. Their diagnosis is often incidental, following surgery. Our goal was to examine the early management strategies for uterine sarcomas, and to assess the impact of guideline adherence and expert center referral on both the management approaches and the clinical outcomes in patients with uterine sarcomas.
METHODS
We retrospectively analyzed medical records from patients with uterine sarcoma referred to the Institut Curie and registered in the database of the French NETSARC network.
RESULTS
In total, 100 patients, with a median age of 54 years, were included in the analyses. On MRI scans (n = 36), all patients had at least two signs suggestive of malignancy, and 77.8 % had four or more signs. No preoperative biopsy was performed in 65.6 % of cases. Only 14.1 % of patients underwent initial surgery at an expert center. Surgery performed outside the network was significantly associated with morcellation (32.9 % vs. 0 %; p = 0.036), fewer negative margins (R0 margins 52.4 % vs. 100 %; p = 0.006), and poor adherence to surgical guidelines (28.3 vs. 72.7 %; p = 0.013). Multivariate analysis showed that non-adherence to surgical recommendations was not significantly associated with relapse-free survival (HR = 0.54; 95 % CI [0.21-1.38]), but was an independent predictor of poor overall survival (HR = 0.12; 95 % CI [0.03-0.52]; p = 0.005).
CONCLUSION
Despite a high frequency of suspicious clinical and radiological signs, a large proportion of women undergoing sarcoma surgery are treated outside of expert networks. We provide guidelines, integrating the clinical context and radiological signs to encourage early referral to reference centers for sarcoma.
Topics: Humans; Female; Middle Aged; Retrospective Studies; Guideline Adherence; Sarcoma; Uterine Neoplasms; Pelvic Neoplasms; Soft Tissue Neoplasms; Referral and Consultation
PubMed: 38159391
DOI: 10.1016/j.ejso.2023.107319 -
PLoS Medicine Dec 2023Hysteroscopic resection is the first-choice treatment for symptomatic type 0 and 1 fibroids. Traditionally, this was performed under general anesthesia. Over the last... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hysteroscopic resection is the first-choice treatment for symptomatic type 0 and 1 fibroids. Traditionally, this was performed under general anesthesia. Over the last decade, surgical procedures are increasingly being performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating safety and effectiveness of hysteroscopic myomectomy under procedural sedation are lacking. This study aims to investigate whether hysteroscopic myomectomy under procedural sedation and analgesia with propofol is noninferior to hysteroscopic myomectomy under general anesthesia.
METHODS AND FINDINGS
This was a multicenter, randomized controlled noninferiority trial conducted in 14 university and teaching hospitals in the Netherlands between 2016 and 2021. Inclusion criteria were age ≥18 years, maximum number of 3 type 0 or 1 fibroids, maximum fibroid diameter 3.5 cm, American Society of Anesthesiologists class 1 or 2, and having sufficient knowledge of the Dutch or English language. Women with clotting disorders or with severe anemia (Hb < 5.0 mmol/L) were excluded. Women were randomized using block randomization with variable block sizes of 2, 4, and 6, between hysteroscopic myomectomy under procedural sedation and analgesia (PSA) with propofol or under general anesthesia (GA). Primary outcome was the percentage of complete resections, assessed on transvaginal ultrasonography 6 weeks postoperatively by a sonographer blinded for the treatment arm and surgical outcome. Secondary outcomes were the surgeon's judgment of completeness of procedure, menstrual blood loss, uterine fibroid related and general quality of life, pain, recovery, hospitalization, complications, and surgical reinterventions. Follow-up period was 1 year. The risk difference between both treatment arms was estimated, and a Farrington-Manning test was used to determine the p-value for noninferiority (noninferiority margin 7.5% of incomplete resections). Data were analyzed according to the intention-to-treat principle, including a per-protocol analysis for the primary outcome. A total of 209 women participated in the study and underwent hysteroscopic myomectomy with PSA (n = 106) or GA (n = 103). Mean age was 45.1 [SD 6.4] years in the PSA group versus 45.0 [7.7] years in the GA group. For 98/106 women in the PSA group and 89/103 women in the GA group, data were available for analysis of the primary outcome. Hysteroscopic resection was complete in 86/98 women (87.8%) in the PSA group and 79/89 women (88.8%) in the GA group (risk difference -1.01%; 95% confidence interval (CI) -10.36 to 8.34; noninferiority, P = 0.09). No serious anesthesiologic complications occurred, and conversion from PSA to GA was not required. During the follow-up period, 15 serious adverse events occurred (overnight admissions). All were unrelated to the intervention studied. Main limitations were the choice of primary outcome and the fact that our study proved to be underpowered.
CONCLUSIONS
Noninferiority of PSA for completeness of resection was not shown, though there were no significant differences in clinical outcomes and quality of life. In this study, hysteroscopic myomectomy for type 0 and 1 fibroids with PSA compared to GA was safe and led to shorter hospitalization. These results can be used for counseling patients by gynecologists and anesthesiologists. Based on these findings, we suggest that hysteroscopic myomectomies can be performed under PSA in an outpatient setting.
TRIAL REGISTRATION
The study was registered prospectively in the Dutch Trial Register (NTR 5357; registration date: 11 August 2015; Date of initial participant enrollment: 18 February 2016).
Topics: Humans; Female; Middle Aged; Adolescent; Uterine Myomectomy; Uterine Neoplasms; Propofol; Quality of Life; Leiomyoma; Analgesia; Anesthesia, General; Pain
PubMed: 38153958
DOI: 10.1371/journal.pmed.1004323