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Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients |
Luca Carmignania,Maria Chiara Clementia,Claudia Signorinia,Gloria Mottaa,Sebastiano Nazzania,*(),Franco Palmisanob,Elisa De Lorenzisb,Michele Catellanic,Alessandro Francesco Mistrettac,Andrea Contic,Valeria Tringalic,Maria Beatrice Costad,Damiano Vizzielloa
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aPoliclinico San Donato, Urology, San Donato, Milanese, Italy bOspedale Maggiore Policlinico, Urology, Milan, Italy cIstituto Europeo di Oncologia, Urology, Milan, Italy dOspedale San Giuseppe, Urology, Milan, Italy |
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Abstract Objective: We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). Methods: We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m 2): Normal weight (18.5 ≤ BMI<25; Group A), overweight (25 ≤ BMI<30; Group B) and obese (BMI≥30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. Results: The median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups>0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization (p > 0.05). Conclusion: Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.
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Received: 03 March 2017
Available online: 17 May 2018
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Corresponding Authors:
Sebastiano Nazzani
E-mail: sebastiano.nazzani@yahoo.com
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Parameters | Group A 18.5 kg/m2≤ BMI < 25 kg/m2 n = 177 | Group B + C BMI ≥ 25 kg/m2 n = 235 | Group C BMI ≥ 30 kg/m2 n = 54 | p-Value A vs. B | p-Value A vs. C | Age, year; mean (SD)/median (IQR) | 70 (11) | 69 (10) | 68 (8.5) | 0.853 | 0.804 | PSA, ng/mL; mean (SD)/median (IQR) | 2.50 (2.96) | 2.91 (3.7) | 3.34 (3) | 0.241 | 0.163 | Prostate volume, mL; mean (SD)/median (IQR) | 60 (47.65) | 75 (52) | 78.5 (45) | <0.001 | 0.003 | Indwelling catheter, n (%) | Yes | 47 (25.4) | 51 (21.7) | 8 (14.8) | | | No | 130 (74.6) | 184 (78.3) | 46 (85.2) | 0.232 | 0.077 | Diabetes, n (%) | Yes | 17 (9.6) | 33 (14.0) | 10 (19) | | | No | 125 (70.6) | 148 (63) | 34 (62) | | | Unknown | 35 (19.8) | 54 (23) | 10 (19) | 0.157 | 0.078 | Alpha blocker, n (%) | Yes | 116 (65.5) | 167 (71) | 39 (72.2) | | | No | 61 (34.5) | 68 (29) | 15 (27.8) | 0.253 | 0.361 | Antiplatelet or anticoagulant medications, n (%) | Acetylsalicylic acid | 37 (21) | 60 (25.5) | 15 (27.8) | 0.310 | 0.290 | Other antiplatelet drugs | 9 (5.0) | 8 (3.4) | 1 (1.8) | 0.537 | 0.307 | Anticoagulant drugs | 13 (7.4) | 14 (6) | 4 (7.4) | 0.905 | 0.988 | No | 118 (66.6) | 153 (65.1) | 34 (63.0) | 0.163 | 0.051 | ASA score, n (%) | 1 | 31 (17.5) | 38 (16.1) | 6 (11.1) | 0.837 | 0.261 | 2 | 110 (62.7) | 154 (65.6) | 35 (64.8) | 0.495 | 0.597 | 3 | 36 (19.8) | 43 (18.3) | 13 (24.1) | 0.280 | 0.495 | 4 | 0 | 0 | 0 | 0 | 1 | IPSS preop, median (IQR) | 19 (8.75) | 20 (10) | 18 (10) | 0.236 | 0.603 | QoL score preop, median (IQR) | 4 (2) | 4 (2) | 4 (2) | 0.206 | 0.681 | Qmax, mL/s preop; median (IQR) | 8.4 (4.6) | 8.0 (3.9) | 8.5 (3.6) | 0.702 | 0.913 | PVR, mL preop; median (IQR) | 122 (145) | 120 (152.5) | 109 (160) | 0.743 | 0.968 | Operative time (min); median (IQR) | 70 (40) | 75 (40) | 85 (50) | 0.096 | 0.066 | Hb decrease (g/dL); median (IQR) | 1 (1.28) | 1 (1.2) | 0.8 (1.15) | 0.600 | 0.031 | Bladder irrigation time (h); median (IQR) | 20 (6) | 20 (6) | 20 (6) | 0.684 | 0.758 | Catheterization time (h); median (IQR) | 34 (20) | 28 (22) | 28 (19.5) | 0.710 | 0.951 | Hospital stay (day); median (IQR) | 2 (1) | 2 (1) | 2 (1) | 0.902 | 0.732 | 1 month IPSS, median (IQR) | 8 (7) | 8 (4) | 7 (5) | 0.356 | 0.161 | 1 month QoL score, median (IQR) | 2 (2) | 2 (2) | 1 (2) | 0.170 | 0.028 | 1 month Qmax, mL/s; median (IQR) | 16.6 (9.35) | 16.1 (10.3) | 18 (11.78) | 0.880 | 0.262 | 1 month PVR (mL); median (IQR) | 30 (39) | 40 (86) | 25 (83.5) | 0.030 | 0.570 | 3 month IPSS, median (IQR) | 5 (6.25) | 5 (6) | 6 (5) | 0.765 | 0.475 | 3 month QoL score, median (IQR) | 1 (2) | 1 (2) | 1 (2) | 0.839 | 0.830 | 3 month Qmax, mL/s; median (IQR) | 21 (9.48) | 20 (9.78) | 21.35 (10.8) | 0.727 | 0.380 | 3 month PVR, mL; median (IQR) | 15 (28.5) | 0 (51) | 15 (76) | 0.869 | 0.380 | AUR with recatheterization (Clavien II), n | 18 | 29 | 7 | 0.709 | 0.650 | Delayed morcellation (Clavien IIIa), n | 1 | 1 | 0 | 0.840 | 0.580 | Transfusion rate, n | 4 | 1 | 0 | 0.169 | 0.575 | UTI (Clavien II), n | 0 | 2 | 1 | 0.131 | 0.070 | MI/stroke (Clavien IV), n | 1 | 1 | 0 | 0.840 | 0.580 | Bladder injury (Clavien I), n | 1 | 0 | 0 | 0.249 | 0.580 |
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Patients characteristics, preoperative functional characteristics, perioperative data, 1 and 3 months follow-up functional data, and postoperative complications.
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