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The Canadian Journal of Urology Aug 2021INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia... (Review)
Review
UNLABELLED
INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia (BPH) for decades. With the desire to reduce hospital stay, complications, and cost, less invasive procedures gained usage in the 1990's. With the advent of a soft tissue morcellator, holmium laser enucleation of the prostate (HoLEP) was introduced as an efficacious alternative to TURP and due to its advantageous side effect profile compared to TURP, has grown in popularity ever since. HoLEP has become a size-independent guideline endorsed procedure of choice for the surgical treatment of BPH.
MATERIALS AND METHODS
We provide a review on the evolution of HoLEP as a gold standard compared to the historical reference procedures for BPH, and provide a review of emerging laser technologies.
RESULTS
A growing body of literature has shown HoLEP to be a safe and efficient procedure for the treatment of BPH for all prostate sizes. Long term studies have proven the durability of HoLEP, as a first line surgical therapy for BPH.
CONCLUSIONS
HoLEP is a proven modality for the surgical treatment of BPH. It can be performed on patients with high risk for postoperative bleeding, or after previous prostate reducing procedures. HoLEP is the only procedure that is AUA guideline-endorsed for all prostate sizes for the surgical treatment of BPH. Given these considerations, HoLEP has become the new gold-standard for the surgical treatment of BPH.
Topics: Humans; Laser Therapy; Lasers, Solid-State; Male; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34453422
DOI: No ID Found -
The Canadian Journal of Urology Aug 2019Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men... (Review)
Review
INTRODUCTION
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men greater than 70 affected. Historically, transurethral resection of the prostate (TURP) has been considered the historical gold standard in the treatment of LUTS due to BPH for many years, contemporary literature indicates that holmium laser enucleation of the prostate (HoLEP) has replaced TURP and open simple prostatectomy as the size independent surgical gold standard for BPH treatment.
MATERIALS AND METHODS
In this review, we discuss the current techniques utilized, outcomes and safety, as well as the long term durability of results. Adverse events associated with the HoLEP procedure, both enucleation and morcellation, are covered as well.
RESULTS
HoLEP has a robust body of literature supporting the technique, which demonstrates its ability to surpass other surgical BPH procedures, including TURP and open simple prostatectomy. Additionally, there is long term durability of both subjective and objective outcomes greater than 10 years associated with this procedure. One randomized trial showed specific postoperative outcome measures that were superior to TURP at 7 years of follow up, including Qmax (4.36 mL/s improvement), erectile function (2.39 points improvement on the IIEF erectile function section), and weight of prostate removed (15.7 grams greater), while other studies have shown greater reduction in postoperative PSA, lower detrusor pressure at Qmax, and more.
CONCLUSIONS
Overall, HoLEP has proven to be an extremely durable and effective treatment for patients suffering from LUTS due to BPH. Both the Europeans and AUA guidelines on the surgical treatment of BPH recommend HoLEP as a size-independent treatment option for those men with moderate to severe symptoms. HoLEP is an excellent option for many patients who may not be good candidates for other procedures based on prostate size, age, or bleeding risk.
Topics: Holmium; Humans; Laser Therapy; Lasers, Solid-State; Male; Prostatic Hyperplasia; Prostatism; Treatment Outcome
PubMed: 31481144
DOI: No ID Found -
Middle East African Journal of... 2018Uveal melanoma is the most common intraocular malignant tumor, with the choroid being the most common site. Management of choroidal melanoma has evolved greatly over the... (Review)
Review
Uveal melanoma is the most common intraocular malignant tumor, with the choroid being the most common site. Management of choroidal melanoma has evolved greatly over the past years. In the past, the conventional method of treatment was enucleation of the affected eye with a debate regarding the effect of enucleation to promote or prevent metastasis. However, nowadays, there are many therapeutic options available including plaque radiotherapy, proton beam radiotherapy, argon laser photocoagulation, transpupillary thermotherapy, stereotactic radiotherapy using gamma knife, enucleation, and surgical resection of the tumor whether through transscleral approach "Exoresection" or less commonly through internal resection approach "Endoresection." The indications and complications of each technique are reviewed. Although radiotherapy is the primary treatment of choroidal melanoma in most ocular oncology centers, it is used as an adjuvant therapy in combination with surgical resection. Preoperative stereotactic radiotherapy before endoresection and brachytherapy to the surgical bed in both exo and endoresection can effectively decrease the recurrence rate. In this article, we will focus on surgical resection of choroidal melanoma whether endoresection or exoresection. We collected data published in indexed journals and related books.
Topics: Choroid Neoplasms; Humans; Melanoma; Ophthalmologic Surgical Procedures
PubMed: 30122851
DOI: 10.4103/meajo.MEAJO_73_18 -
The Angle Orthodontist Jul 1976A study was made on 27 cases where enucleation of four first premolars was performed simultaneously without introduction of mechanical devices to influence space... (Comparative Study)
Comparative Study
A study was made on 27 cases where enucleation of four first premolars was performed simultaneously without introduction of mechanical devices to influence space closure. The results suggested that: 1. Enucleation of premolars can be used to minimize the severity of crowding in arch-length deficiency cases. 2. There is no damage to the remaining teeth and alveolar process when enucleation is accomplished with good surgical technique. 3. The average amount of lingual tipping of the mandibular incisors in approximately four years subsequent to the enucleation procedure was 4.1 degrees. 4. This amount of lingual tipping compares quite favorably with the amount of lower incisor uprighting experienced during growth and could not be considered excessive. 5. The mandible does tend to rotate in a counterclockwise manner following enucleation of four first premolars without appliance therapy. This rotation was considered significant in comparison with the amount of rotation that could be expected from an untreated sample. 6. If orthodontic treatment is planned, the enucleation of the manddibular second premolars in borderline extraction cases to avoid excessive lingual tipping of the mandibular incisors would seem to be questionable. 7. Various combinations of enucleation and tooth extraction may be helpful in treatment planning. 8. With judicious timing the enucleation of four first premolars can minimize the severity of the malocclusion simplifying appliance therapy if proper diagnosis and good surgical technique are employed. 9. Although conventional serial extraction may accomplish similar ends, it would appear that enucleation would offer some advantages in terms of autonomous adjustment of the mandibular incisors and root positioning of mandibular cuspids. 10. Enucleation cases usually require fewer traumatic surgical procedures and less supervision by the orthodontist. 11. The parents should be informed that serial extraction procedures including enucleation may simplify but will not eliminate the need for appliance therapy.
Topics: Bicuspid; Bone Resorption; Child; Dental Arch; Face; Female; Humans; Incisor; Male; Malocclusion; Mandible; Rotation; Serial Extraction; Tooth, Unerupted
PubMed: 1066974
DOI: 10.1043/0003-3219(1976)046<0219:PE>2.0.CO;2 -
The Canadian Journal of Urology Oct 2015Laser treatment of benign prostatic hyperplasia (BPH) through enucleation techniques has become increasingly more utilized in the field of urology. Laser enucleation of... (Comparative Study)
Comparative Study Review
INTRODUCTION
Laser treatment of benign prostatic hyperplasia (BPH) through enucleation techniques has become increasingly more utilized in the field of urology. Laser enucleation of the prostate (LEP) is a transurethral procedure that employs several different types of lasers to dissect the adenoma from the surgical capsule in a retrograde fashion.
MATERIALS AND METHODS
We review basic laser physics and current laser prostate enucleation techniques. Holmium-LEP (HoLEP), Thulium-LEP (ThuLEP), Greenlight-LEP (GreenLEP) and Diode-LEP (DiLEP) applications are discussed. We summarize the current literature with respect to functional outcomes and complications.
RESULTS
Although each laser device used for prostate enucleation has the same goal of removal of the adenoma from the surgical capsule, each has unique characteristics (i.e. wavelength, absorption rates) that must be understood by the practicing surgeon. Mastery of one LEP technique does not necessarily translate into facile use of an alternative enucleation energy source and/or approach. The various LEP techniques have demonstrated similar, if not superior, postoperative results to transurethral resection of the prostate (TURP), the current gold standard in the treatment of BPH.
CONCLUSIONS
This article outlines the current LEP techniques and should serve as a quick reference for the practicing urologist.
Topics: Aged; Aged, 80 and over; Blood Loss, Surgical; Follow-Up Studies; Humans; Laser Therapy; Lasers, Solid-State; Male; Minimally Invasive Surgical Procedures; Operative Time; Prostatic Hyperplasia; Risk Assessment; Severity of Illness Index; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 26497344
DOI: No ID Found -
Frontiers in Surgery 2022To compare the safety and efficacy of enucleation and hepatectomy for the treatment of hepatic hemangioma (HH). (Review)
Review
OBJECTIVE
To compare the safety and efficacy of enucleation and hepatectomy for the treatment of hepatic hemangioma (HH).
METHODS
A systematic literature search was conducted to identify studies evaluating enucleation versus hepatectomy for HH starting from the time of database creation to February 2022. Extraction of the data used in this study was done from the literature. The differences between the two surgical approaches were evaluated by comparing and analyzing the relevant data by means of meta-analysis.
RESULTS
A total of 1,384 patients (726 underwent enucleation, and 658 with hepatectomy) were included in our meta-analysis from 12 studies. Enucleations were associated with favorable outcomes in terms of operation time [mean difference (MD): -39.76, 95% confidence interval (CI): -46.23, -33.30], blood loss (MD: -300.42, 95% CI: -385.64, -215.19), length of hospital stay (MD: -2.33, 95% CI: -3.22, -1.44), and postoperative complications (OR: 0.57, 95% CI: 0.44-0.74). There were no differences between the groups in terms of patients needing transfusion (OR: 0.85, 95% CI: 0.50, 1.42), inflow occlusion time (MD: 1.72, 95% CI: -0.27, 3.71), and 30-day postoperative mortality (OR: 0.23, 95% CI: 0.02-2.17).
CONCLUSION
Compared with hepatectomy, enucleation is found to be effective at reducing postoperative complications, blood loss, and operation time and shortening the length of hospital stay. Enucleation is similar to hepatectomy in terms of inflow occlusion time, 30-day postoperative mortality, and patients needing transfusing to hepatectomy.
PubMed: 35965862
DOI: 10.3389/fsurg.2022.960768 -
The Journal of Craniofacial SurgeryThe indications for evisceration and enucleation are still evolving and controversial. The study aims to describe trends of enucleation versus evisceration in one center.
PURPOSE
The indications for evisceration and enucleation are still evolving and controversial. The study aims to describe trends of enucleation versus evisceration in one center.
METHODS
In period 1998-2019 were 353 patients were included in the study. Statistical results and Chi-square test for pair-wise comparisons for the statistical significance in comparing two subgroups (years periods 1998-2008 and 2009-2019) per category have been evaluated.
RESULTS
The enucleation was performed in 306 patients, and the evisceration was performed in 47 patients. In 221 patients with the tumor exclusively enucleation was indicated. For the operation technique, the authors got a chi-square value of 0.027, and the associated P value is at 0.8695, then the number of evisceration and enucleation in subgroups have not confirmed independency. For the tumor presence, the authors got a chi-square value of 5.4, and the associated P value is at 0.02, then the number of validated/nonvalidated tumor presence in subgroups confirmed independency.
CONCLUSIONS
The performed enucleations had 98% cases uveal melanoma, 1% of cases of another type of malignancy (lymphoma non-Hodgkin type), and 1% cases with benign tumor. Enucleation is also today most frequently due to malignant intraocular tumors, whereas evisceration if most frequently for the phthisis eye after a trauma or a previous intraocular surgery. In our study in 22 years interval also in the second period, there was an increased trend of enucleation due to intraocular malignancy. It can have many reasons, especially, that patients are sent to oncology centers late in the advanced stage of tumor.
Topics: Eye Diseases; Eye Enucleation; Eye Evisceration; Humans; Retrospective Studies; Uveal Neoplasms
PubMed: 34015800
DOI: 10.1097/SCS.0000000000007727 -
Ophthalmology Oct 2023To report a previously unrecognized choroidal melanoma clinical feature termed tumor-associated retinal pigmentation (TARP) and determine any correlation with tumor...
PURPOSE
To report a previously unrecognized choroidal melanoma clinical feature termed tumor-associated retinal pigmentation (TARP) and determine any correlation with tumor biology.
DESIGN
Imaging and histologic analysis of a retrospective cohort of patients.
PARTICIPANTS
Patients with choroidal melanoma identified as having TARP on funduscopy at the Liverpool Ocular Oncology Centre (LOOC), United Kingdom, from January 2020 through January 2023.
METHODS
Clinical and imaging characteristics of patients diagnosed with choroidal melanoma and exhibiting TARP on fundoscopy were documented. Details of these choroidal melanomas were collated and correlated with histopathology and molecular genetic reports. The chromosome 3 status of each tumor was assessed. In enucleated samples, immunostaining was undertaken to determine the nature of the TARP using specific markers (CD68 and MelanA).
MAIN OUTCOME MEASURES
Features of TARP on widefield fundus color imaging, fundus autofluorescence (FAF), and OCT were described. Tumor chromosome 3 status and the immunoprofile of the TARP also were collated.
RESULTS
Tumor-associated retinal pigmentation had a prevalence rate of 7.47 per 100 cases of choroidal melanoma at the LOOC. Twenty-three eyes with TARP were analyzed, with a mean age of 71.4 years (range, 51-88 years). The median largest basal diameter was 16.10 mm (range, 9.17-21.32 mm), and the mean tumor thickness was 8.04 mm (range, 1.40-13.80 mm). Tumor-associated retinal pigmentation was observed on widefield color fundus imaging, with hypofluorescence on FAF images and represented hyperreflective foci located in intraretinal and subretinal spaces on OCT scans. Seventeen patients (73.9%) underwent enucleation, and 6 patients (26.1%) underwent globe-sparing treatment. Molecular genetic analysis of 20 choroidal melanomas (after enucleation or radiotherapy biopsy) revealed monosomy 3 in 18 tumors (90%). Immunostaining of the TARP in enucleated eyes showed CD68+ melanophages in all 17 patients appearing as scattered cells and aggregates; MelanA findings were negative.
CONCLUSIONS
Tumor-associated retinal pigmentation represents tumor-associated macrophages, not melanocytes, within intraretinal and subretinal spaces of larger choroidal melanomas. Radiation treatments need not involve this area in the treatment plan, minimizing radiation-related complications. This novel clinical sign seems to be linked to tumors of high metastatic-risk clinical and genetic characteristics, with a preponderance having monosomy 3 anomalies.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; Aged; MART-1 Antigen; Retrospective Studies; Choroid Neoplasms; Melanoma; Pigmentation; Monosomy; Fluorescein Angiography
PubMed: 37182744
DOI: 10.1016/j.ophtha.2023.05.009 -
Asian Journal of Urology Jan 2018In the past 2 decades, endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia (BPH), with comparable... (Review)
Review
In the past 2 decades, endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia (BPH), with comparable outcomes to traditional surgeries. Transurethral vapor enucleation and resection of the prostate (TVERP), transurethral vapor enucleation of the prostate (TVEP), and ultrasound-navigated TVEP (US-TVEP) are new, innovative endoscopic enucleation procedures. These procedures are named Xie's Prostate Enucleations (Xie's Procedures for short). Current clinical data indicate that Xie's Procedures are safe and effective treatment options for patients with BPH, especially for patients with larger prostates. Further prospective, randomized clinical trials compared with traditional transurethral resection of prostate (TURP) are still needed.
PubMed: 29379730
DOI: 10.1016/j.ajur.2017.11.001