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1. Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Author: Bryan Kwun-Chung Cheng, Steffi Kar-Kei Yuen, Daniele Castellani, Marcelo Langer Wroclawski, Hongda Zhao, Mallikarjuna Chiruvella, Wei-Jin Chua, Ho-Yee Tiong, Yiloren Tanidir, Jean de la Rosette, Enrique Rijo, Vincent Misrai, Amy Krambeck, Dean S. Elterman, Bhaskar K. Somani, Jeremy Yuen-Chun Teoh, and Vineet Gauhar
Subjects: Benign prostate hyperplasia, Minimal invasive surgical therapy, Surgery, Bladder outlet obstruction, Diseases of the genitourinary system. Urology, RC870-923
Abstract: Objective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitudes, and practices for benign prostatic obstruction surgeries. Methods: A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were “agree or strongly agree” and less than or equal to 15% responses were “disagree or strongly disagree” (consensus agree), or when more than or equal to 70% responses were “disagree or strongly disagree” and less than or equal to 15% responses were “agree or strongly agree” (consensus disagree). Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion: Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.
Published: 2024
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2. Current Advances in Immune Checkpoint Inhibition and Clinical Genomics in Upper Tract Urothelial Carcinoma: State of the Art

Author: Gianluigi Califano, Idir Ouzaid, Paul Laine-Caroff, Arthur Peyrottes, Claudia Collà Ruvolo, Benjamin Pradère, Vincent Elalouf, Vincent Misrai, Jean-François Hermieu, Shahrokh F. Shariat, and Evanguelos Xylinas
Subjects: upper tract urothelial carcinoma, prognosis, immune check point inhibition, radical nephroureterectomy, genetics, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Upper tract urothelial carcinoma (UTUC) is a rare and challenging-to-treat malignancy. In most patients it is a sporadic tumor entity, less commonly it falls on the spectrum of Lynch syndrome, an autosomal dominant familial tumor syndrome. Localized UTUC with high-risk features as well as the metastatic disease scenario might require systemic therapy. Platinum-based combination chemotherapy is currently the recommended management option. However, the introduction of immune checkpoint inhibitors into the therapeutic armamentarium has led to a paradigm shift in treatment standards. Immunotherapy has been shown to be safe and effective in treating at least metastatic UTUC, although UTUC-specific high-level evidence is still lacking. Recent technological advances and noteworthy research efforts have greatly improved the general understanding of the biological landscape of UTUC. According to the main findings, UTUC represent a particular subtype of urothelial carcinoma frequently associated with activated FGFR3 signaling, a luminal–papillary phenotype and a T-cell-depleted microenvironment. This improved knowledge promises precision oncology approaches that match treatment decision strategies and genomic profile to ultimately result in better clinical outcomes. The aim of this review was to summarize the main currently available evidence on immune checkpoint inhibition and clinical genomics in UTUC.
Published: 2022
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3. Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Author: Lutfi Tunc, Giorgio Bozzini, Cesare Marco Scoffone, Selcuk Guven, Thomas Hermann, Angelo Porreca, Vincent Misrai, Sascha Ahyai, Murat Zor, Emin Aksoy, and Ali S. Gozen
Subjects: Benign prostate hyperplasia, Laser enucleation of prostate, Cadaveric model, Training, Content validity, Diseases of the genitourinary system. Urology, RC870-923, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Background: Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective: To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants: Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis: The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations: A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions: Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary: An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.
Published: 2021
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4. Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Author: Muhieddine Labban, Nassib Abou Heidar, Vincent Misrai, Jad Najdi, Hani Tamim, and Albert El-Hajj
Subjects: benign prostatic obstruction, endoscopic enucleation of the prostate, perioperative outcomes, robotic-assisted simple prostatectomy, Diseases of the genitourinary system. Urology, RC870-923
Abstract: ObjectiveTo compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). MethodsThe national surgical quality improvement program database was queried for AEEP, RASP, and OSP procedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. ResultsWe identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. ConclusionAEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.
Published: 2021
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5. Multicenter experience with photoselective vaporization of the prostate on men taking novel oral anticoagulants

Author: Brooke Sachs, Vincent Misrai, Shahin Tabatabaei, and Henry H. Woo
Subjects: Benign prostatic hyperplasia, Benign prostatic obstruction, Photoselective vaporisation of the prostate, Non-vitamin K oral anticoagulants, Novel oral anticoagulants, Diseases of the genitourinary system. Urology, RC870-923
Abstract: Objective: Photoselective vaporization of the prostate (PVP) is a widely performed surgical procedure for benign prostatic obstruction. This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants (NOACs). This study was to examine the perioperative outcomes in men on NOACs undergoing PVP, with particular reference to perioperative morbidity. Methods: A retrospective analysis of PVP datasets was undertaken from three centres in Sydney (Australia), Toulouse (France) and Boston (USA). Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified. Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo (CD) classification. Results: There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period. The mean age was 77±6.5 years. The mean prostate volume, energy utilization and vaporisation time was 94±56 mL, 301±211 kJ, and 35±21 min respectively. The mean postoperative duration of catheterization and duration of hospitalization was 2.2±2.4 days and 2.4±2.4 days respectively. There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions. Conclusions: This study supports the safety of men on NOACs undergoing PVP. Whilst this study represents the largest experience of PVP in these men, larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.
Published: 2020
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6. Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

Author: Mihir Desai, Dean Elterman, Peter Gilling, Claus Roehrborn, Neil Barber, Vincent Misrai, Kevin C Zorn, Naeem Bhojani, Alexis Te, Mitch Humphreys, Steven Kaplan, and Thorsten Bach
Subjects: Medical technology, R855-855.5, Surgery, RD1-811
Abstract: Objectives To evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups.Design A meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER.Setting Australia, Canada, Lebanon, Germany, New Zealand, UK and the USA.Participants 425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up.Interventions Aquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate.Main outcome measures The analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment.Results 425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates 4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%–2.0%).Conclusions Across a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.
Published: 2021
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7. A Standardized Method for Estimating the Carbon Footprint of Disposable Minimally Invasive Surgical Devices

Author: Vincent Misrai, MD, Enrique Rijo, MD, PhD, Jean-Baptiste Cottenceau, Kevin C. Zorn, MD, Dmitry Enikeev, MD, Dean Elterman, MD, Naeem Bhojani, MD, Alexandre De La Taille, MD, PhD, Thomas R. W. Herrmann, MD, PhD, Gregoire Robert, MD, PhD, Benjamin Pradere, MD, and the members of the French scientific committee for Male Lower Urinary Tract Symptoms (Association Francaise d’Urologie)
Subjects: Surgery, RD1-811
Abstract: Objective:. To propose a standardized methodology for estimating the embodied carbon footprint (CF) of disposable minimally-invasive surgical devices (MISDs) and their application in new benign prostatic hyperplasia (BPH) MISDs. Summary of Background Data:. The estimation of the CO2e emissions of disposable surgical devices is central to empowering the healthcare supply chain. Methods:. The proposed methodology relied on a partial product lifecycle assessment and was restricted to a specific part of scope 3, which comprised the manufacturing of surgical device- and non–device-associated products (NDAPs), including packaging and user manual. The process-sum inventory method was used, which involves collecting data on all the component processes underpinning disposable MISDs. The seven latest disposable MISDs used worldwide for transurethral prostatic surgery were dismantled, and each piece was categorized, sorted into the appropriate raw material group, and weighed. The CF was estimated according to the following formula: activity data (weight of raw material) × emission factors of the corresponding raw material (kg CO2e/kg). Results:. The total weights of disposable packaging and user manuals ranged from 0.062 to 1.013 kg. Plastic was the most common and least emissive raw material (2.38 kg CO2e/kg) identified. The estimated embodied CF of MISDs ranged from 0.07 to 3.3 kg CO2e, of which 9% to 86% was attributed to NDAPs. Conclusions:. This study described a simple and independent calculation method for estimating the embodied CF of MISDs. Using this method, our results showed a wide discrepancy in the estimated CO2 emissions of the most recent disposable MISDs for transurethral BPH surgery. Thus, the lack of CF information should be of major concern in the development of future MISDs.
Published: 2021
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8. The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature

Author: Dominique Thomas, Kevin C. Zorn, Malek Meskawi, Ramy Goueli, Pierre-Alain Hueber, Lesa Deonarine, Vincent Misrai, Alexis Te, and Bilal Chughtai
Subjects: Diseases of the genitourinary system. Urology, RC870-923
Abstract: Objective: Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results: Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p
Published: 2019
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9. While the Chatbot's Away, the Mice Will Play

Author: Vincent Misrai, Dominique Pon, and Hélène Charbonneau
Subjects: artificial intelligence, healthcare, digital assistants, electronic health record, voice assistance systems, Medicine, Public aspects of medicine, RA1-1270, Electronic computers. Computer science, QA75.5-76.95
Published: 2021
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10. Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database

Author: Claudia Deyirmendjian, David-Dan Nguyen, Kyle W. Law, Anna-Lisa V. Nguyen, Iman Sadri, Adel Arezki, David Bouhadana, Ahmed Ibrahim, Naeem Bhojani, Dean S. Elterman, Bilal Chughtai, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin C. Zorn
Subjects: Urology
Published: 2023
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11. Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database

Author: Nicholas Corsi, David-Dan Nguyen, Adel Arezki, Iman Sadri, Kyle Law, David Bouhadana, Claudia Deyirmendjian, Naeem Bhojani, Dean S. Elterman, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, Bilal Chughtai, and Kevin C. Zorn
Subjects: Urology
Abstract: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates ( 80 cc).Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe.3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28).Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.
Published: 2022
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12. Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients

Author: Vladislav, Petov, Diana, Babaevskaya, Mark, Taratkin, Leonid, Chuvalov, Lukas, Lusuardi, Vincent, Misrai, Roman, Sukhanov, Cesare M, Scoffone, and Dmitry, Enikeev
Subjects: Male, Urinary Incontinence, Stress, Urology, Prostate, Prostatic Hyperplasia, Transurethral Resection of Prostate, Lasers, Solid-State, Middle Aged, Treatment Outcome, Thulium, Quality of Life, Humans, Laser Therapy, Prospective Studies, Aged
Published: 2022
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13. The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review

Author: Glyn Burtt, Cassandra Springate, Alison Martin, Emily Woodward, Paul Zantek, Feras Al Jaafari, Gordon Muir, and Vincent Misrai
Subjects: Urology
Abstract: To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2-29 falling to 2.3-10.8 for IPSS, 0-19 mL/s increasing to 7.5-34.1 mL/s for Qmax and 41.4-954 mL falling to 5.1-138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
Published: 2022
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14. MP51-06 SAFETY AND EFFICACY OF GREENLIGHT PVP IN OCTOGENARIANS: EVALUATION OF THE GLOBAL GREENLIGHT GROUP DATABASE

Author: Claudia Deyirmendjian, David-Dan Nguyen, Kyle Law, Anna-Lisa Nguyen, Iman Sadri, Adel Arezki, David Bouhadana, Ahmed Ibrahim, Naeem Bhojani, Dean Elterman, Bilal Chughtai, Franck Bruyere, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin Zorn
Subjects: Urology
Published: 2023
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15. Pharmacologic and Surgical Retreatment After Office-based Treatments for Benign Prostatic Hyperplasia: A Systematic Review

Author: Michael Baboudjian, Jean-Nicolas Cornu, Bastien Gondran-Tellier, Marc Fourmarier, Grégoire Robert, Benoit Peyronnet, Vincent Misrai, and Benjamin Pradere
Subjects: Urology
Published: 2023
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16. Learning curve in aquablation: an international multicenter study

Author: Albert El Hajj, Vincent Misrai, Ali A. Nasrallah, Muhieddine L. Labban, Jad A. Najdi, and Enrique Rijo
Subjects: Ablation Techniques, Male, Treatment Outcome, Lower Urinary Tract Symptoms, Urology, Prostatic Hyperplasia, Humans, Learning Curve, Retrospective Studies
Abstract: To describe and analyze the learning curve (LC) of aquablation for the treatment of benign prostatic obstruction and determine the number of cases needed to achieve acceptable surgical safety, efficiency, and efficacy.A retrospective analysis of prospectively maintained aquablation databases from France, Lebanon, and Spain was conducted. The combined LC of three surgeons was defined by trifecta and pentafecta outcomes. Trifecta reflected efficiency and safety: operative time 60 min, hemoglobin reduction ≤ 2 mg/dL, and no 90 day Clavien-Dindo grade ≥ 2 complications. Pentafecta reflected effectiveness: percent reduction in International Prostate Symptom Score (IPSS) and ejaculation preservation. The combined LC was plotted using a moving average with polynomial fitting.The cohort included 175 consecutive patients. Median (IQR) prostate volume was 70 (50-91) cc, and baseline IPSS was 23 (18-27). The achievement of trifecta exceeded 50% after 4 cases, and 70% after 50 cases. Pentafecta achievement exceeded 50% after 38 cases. Logistic regression showed significant improvement in hemoglobin reduction and ejaculation preservation. Grade ≥ 2 complication was not affected by experience, and neither was 3 month %IPSS reduction as 94% of patients showed ≥ 50% symptoms' improvement.Aquablation is associated with a quick learning curve for the defined trifecta and pentafecta outcomes. It provided effective LUTS relief and low complication rates independent of surgeon experience. Hemoglobin drop and ejaculatory function preservation were the two factors influenced by the surgeons' LC. Training to reduce operative time, standardization of hemostasis techniques, and early assistance to improve veru-protection zone planning are keys to quicker learning.
Published: 2022
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17. Best nonsurgical managements of acute urinary retention: what's new?

Author: Michael Baboudjian, Benoit Peyronnet, Romain Boissier, Grégoire Robert, Jean-Nicolas Cornu, Vincent Misrai, and Benjamin Pradere
Subjects: Male, Urology, Acute Disease, Prostatic Hyperplasia, Humans, Female, Urinary Retention, Urinary Catheterization, Adrenergic alpha-Antagonists
Abstract: To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR).A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.
Published: 2021
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18. Life Cycle Assessment of Reusable and Disposable Cystoscopes: A Path to Greener Urological Procedures

Author: Michael, Baboudjian, Benjamin, Pradere, Nathalie, Martin, Bastien, Gondran-Tellier, Oriol, Angerri, Tiphaine, Boucheron, Cyrille, Bastide, Esteban, Emiliani, Vincent, Misrai, Alberto, Breda, and Eric, Lechevallier
Subjects: Urology
Abstract: The environmental impact of reusable and disposable devices is unclear; reuse is expected to reduce the carbon footprint, but the environmental impact of reprocessing of reusable devices is increasingly being questioned.The aim was to provide the first rigorous life cycle assessment of reusable and disposable flexible cystoscopes.We performed a life cycle assessment of reusable flexible cystoscopes and the aS4C single-use cystoscope (aScope; Ambu, Ballerup, Denmark). For the aScope, the complete lifespan of the scope was evaluated, including raw material extraction, material formulation, component production, product assembly, distribution, transportation after use, and final disposal. For reusable cystoscopes, we limited our analysis to their reprocessing, using a model consisting of standard high-level disinfection with peracetic acid. The environmental impact was evaluated by an independent third-party consulting company APESA (Technopole Hélioparc, Pau, France) dedicated to such risk assessments.The environmental footprint of both cystoscopes was assessed using five environmental impact categories, namely, climate change, mineral resource depletion, ecotoxicity, acidification, and eutrophication. To perform the life cycle assessment, Simapro v9.3.3 software was used and the Ecoinvent v3.5 database was employed as the primary life cycle inventory database. A Monte Carlo analysis was used to account for the inherent uncertainty in life cycle inventory data and the variability in material and energy consumption for each type of flexible cystoscope.By only comparing the disinfection reprocessing of reusable cystoscopes with the complete lifespan of the single-use cystoscope, the use of the aScope would allow a reduction of at least 33% in the climate change category, 50% in the mineral resources' depletion category, 51% in the ecotoxicity category, 71% in the acidification category, and 49% in the eutrophication category. Our results cannot be generalized to all health care facilities as we studied only one type of reprocessing method and one disposable flexible cystoscope.Disinfection reprocessing of reusable cystoscopes was found to have a significantly larger environmental footprint and impact than the whole lifespan of the single-use cystoscope aScope.Using a cradle-to-grave life cycle analysis, we showed that the environmental footprint of a flexible cystoscopy procedure can be reduced by using a disposable cystoscope instead of a reusable cystoscope.
Published: 2022
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19. Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Author: Emin Aksoy, Thomas Hermann, Murat Zor, Lutfi Tunc, Ali Serdar Gözen, Selcuk Guven, Angelo Porreca, Sascha Ahyai, Giorgio Bozzini, Cesare Marco Scoffone, Vincent Misrai, and Acibadem University Dspace
Subjects: medicine.medical_specialty, Urology, medicine.medical_treatment, education, Enucleation, Laser enucleation of prostate, Education, Likert scale, Benign prostate hyperplasia, Cadaver, Prostate, medicine, Content validity, Training, Medical physics, RC254-282, Transurethral resection of the prostate, business.industry, Gold standard, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Diseases of the genitourinary system. Urology, medicine.anatomical_structure, Cadaveric model, RC870-923, Cadaveric spasm, business
Abstract: Background Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training., Take Home Message Anatomic endoscopic enucleation of the prostate (AEEP) has a steep learning curve and not become widespread due to the lack of a standardized training program. This is the first cadaver study validating a fresh-frozen human cadaver model for AEEP training
Published: 2021
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20. Accuracy of Clarius, Handheld Wireless Point-of-Care Ultrasound, in Evaluating Prostate Morphology and Volume Compared to Radical Prostatectomy Specimen Weight: Is There a Difference between Transabdominal vs Transrectal Approach?

Author: Cristina Negrean, Russell N Schwartz, Naeem Bhojani, Côme Tholomier, Dean Elterman, Ahmed S. Zakaria, Félix Couture, Kevin C. Zorn, Thomas R. W. Herrmann, David-Dan Nguyen, Adel Arezki, Ghizlane Moussaoui, Vincent Misrai, and Iman Sadri
Subjects: medicine.medical_specialty, Transrectal approach, Prostatectomy, business.industry, Urology, medicine.medical_treatment, Point of care ultrasound, Transabdominal ultrasound, medicine.disease, Prostate size, Specimen weight, Prostate cancer, medicine.anatomical_structure, Prostate, medicine, Radiology, business
Abstract: Background: Prostate size estimation is a valuable clinical measure widely utilized in urology. This study evaluated the accuracy of preoperative transabdominal ultrasound (TAUS) compared to radica...
Published: 2021
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21. Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Author: Nassib Abou Heidar, Jad Najdi, Muhieddine Labban, Vincent Misrai, Hani Tamim, and Albert El-Hajj
Subjects: Database, Prostatectomy, business.industry, medicine.medical_treatment, Rasp, Enucleation, Confounding, 030232 urology & nephrology, Perioperative, computer.software_genre, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Propensity score matching, medicine, General Earth and Planetary Sciences, Adverse effect, business, Complication, computer, General Environmental Science
Abstract: Objective: To compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). Methods: The national surgical quality improvement program database was queried for AEEP, RASP, and OSPprocedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. Results: We identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. Conclusion: AEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.
Published: 2021
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22. TURPxit or not: contemporary management options for benign prostatic obstruction

Author: Vincent Misrai, Thomas R. W. Herrmann, Fernando Gomez Sancha, and Thorsten Bach
Subjects: Nephrology, Male, medicine.medical_specialty, business.industry, Urology, General surgery, MEDLINE, Prostatic Hyperplasia, Transurethral Resection of Prostate, Urinary Bladder Neck Obstruction, Editorial, Internal medicine, medicine, Humans, Prostatic obstruction, business
Published: 2021

23. Traitement de la dysfonction érectile par ondes de choc extracorporelles de faible intensité : revue de la littérature

Author: C. Guillot-Tantay, Vincent Misrai, Morgan Rouprêt, and A. Ochoa
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Erectile dysfunction, Extracorporeal shock wave therapy, business.industry, Urology, 030232 urology & nephrology, medicine, business, medicine.disease
Abstract: Resume Introduction Le but de ce travail etait de proposer une revue de la litterature concernant l’efficacite des ondes de chocs (OC) extra-corporelles a faible intensite pour la prise en charge de la dysfonction erectile (DE). Methodes Une revue systematique de la litterature publiee entre 2000 et 2020 a ete realisee selon la methodologie PRISMA. Une recherche sur la base de donnees Medline a ete realisee en utilisant les mots cles (MeSH) suivants : « extracorporeal shock wave therapy » ; « erectile dysfunction » ; « sexuality ». Resultats Dix-neuf articles ont ete retenus : treize essais controles randomises et six meta-analyses. La DE organique primitive d’origine vasculaire a ete majoritairement etudiee. Le traitement par OC a faible intensite etait benefique, lorsque la DE etait evaluee par les scores IIEF, EHS ou l’hemodynamique penienne. Les resultats ne sont cependant pas unanimes. Conclusion Les OC a faible intensite agissent theoriquement sur le phenomene physiopathologique expliquant la DE en ameliorant l’hemodynamique penienne. Leur utilisation dans un contexte de DE organique d’origine vasculaire est soutenue par les recommandations europeennes d’urologie et la Societe europeenne de medecine sexuelle. Des regles simples pour son utilisation en pratique clinique et un protocole bien etabli restent a definir.
Published: 2021
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24. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety

Author: Giovanni Ferrari, David Bouhadana, David-Dan Nguyen, Edgardo F. Becher, Maximilian Reimann, Franck Bruyère, Naeem Bhojani, Carlos Vasquez-Lastra, Dean Elterman, Kyle W Law, Iman Sadri, Vincent Misrai, Félix Couture, Côme Tholomier, Hannes Cash, Ahmed S. Zakaria, Kevin C. Zorn, Luca Cindolo, and Tiago Borelli-Bovo
Subjects: Nephrology, medicine.medical_specialty, business.industry, Urology, Laser treatment, 030232 urology & nephrology, Perioperative, Hyperplasia, medicine.disease, Pooling data, 03 medical and health sciences, Catheter, 0302 clinical medicine, medicine.anatomical_structure, Prostate, Interquartile range, 030220 oncology & carcinogenesis, Internal medicine, medicine, business
Abstract: Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64–77), 64 (47–90), 3.1 ng/mL (1.8–6), and 22 (19–27), respectively. Median lasing and operative time were 34 (23–48) and 62 min (46–85), respectively. Median energy use was 250.0 kJ (168.4–367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p
Published: 2021
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25. Traitement chirurgical et interventionnel de l’obstruction sous-vésicale liée à une hyperplasie bénigne de prostate : revue systématique de la littérature et recommandations de bonne pratique clinique du Comité des Troubles Mictionnels de l’Homme

Author: A. Descazeaud, A. Chevrot, P E Theveniaud, Amine Benchikh, J. Gas, N. Barry Delongchamps, Hervé Baumert, Y. Rouscoff, Grégoire Robert, E. Della Negra, Comité des troubles mictionnels de l’homme de l’Association française d’urologie, S. Lebdai, Sébastien Vincendeau, J Wilisch, B. Pradere, Vincent Misrai, Steeve Doizi, and Marc Fourmarier
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Urology, 030232 urology & nephrology, Medicine, Interventional management, business
Abstract: Resume Objectif L’objectif du Comite des Troubles Mictionnels de l’Homme (CTMH) de l’Association Francaise d’Urologie (AFU) etait de mettre a jour les recommandations francaises parues en 2012 et celles de l’EAU parues en 2019 concernant la prise en charge chirurgicale et interventionnelle de l’obstruction sous-vesicale (OSV) liee a une hyperplasie benigne de prostate (HBP). Methodes Une revue systematique de la litterature (PubMed®), concernant l’OSV liee a l'HBP, a ete conduite entre 2018 et 2020 afin de completer celle prise en compte par les recommandations precedentes. Ce travail a comporte une strategie bibliographique predefinie puis une analyse critique de la litterature avec attribution de niveaux de preuve et redaction de conclusions et de recommandations permettant de repondre aux questions cliniques posees. Resultats/recommandations Proposer une incision cervicoprostatique (ICP) pour traiter chirurgicalement les patients ayant des symptomes du bas appareil urinaire (SBAU) moderes a severes avec un volume prostatique 80 cm3. Les implants intra-prostatiques sont une alternative pour traiter les SBAU chez les patients souhaitant conserver leur fonction ejaculatoire et ayant un volume prostatique Conclusion Les evolutions notables des techniques de prise en charge chirurgicales de l’OSV liee a l’HBP s’orientent vers une diminution de la morbidite des gestes et une amelioration de la qualite de vie au-dela du simple traitement des SBAU.
Published: 2021
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26. Mise au point sur les nouvelles techniques chirurgicales et interventionnelles dans la prise en charge de l’obstruction sous-vésicale liée à l’hyperplasie bénigne de la prostate

Author: Nicolas Barry Delongchamps, Hervé Baumert, Y. Rouscoff, Grégoire Robert, A. Descazeaud, Sébastien Vincendeau, S. Lebdai, P E Theveniaud, Benjamin Pradere, J. Gas, A. Chevrot, Marc Fourmarier, Steeve Doizi, Comité des troubles mictionnels de l’homme de l’Association française d’urologie, Vincent Misrai, J Wilisch, Amine Benchikh, and E D Negra
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Urology, 030232 urology & nephrology, Medicine, business
Abstract: Resume Introduction De nombreuses techniques dites mini-invasives ont emerge ces dernieres annees dans le traitement chirurgical de l’obstruction due a l’hyperplasie benigne de la prostate (HBP). L’objectif de cet article etait de faire le point sur leurs evolutions et leurs resultats respectifs. Materiel et methode Une revue coherente de la litterature entre 2013 et 2020 a ete realisee par un panel d’experts nationaux de la chirurgie de l’HBP. Les donnees ont ensuite ete discutees par l’ensemble des co-auteurs afin d’obtenir un consensus vis-a-vis des articles selectionnes et de leur analyse. Un etat des lieux a enfin ete redige pour proposer une vue d’ensemble de ces avancees technologiques et de leur disponibilite en France. Resultats Le traitement de l’obstruction sous-vesicale liee a l’HBP s’est beaucoup diversifie ces 5 dernieres annees. L’inventaire comporte 5 nouvelles technologies permettant aujourd’hui une desobstruction transuretrale non ablative (UROLIFT®, ITIND®), transuretrale ablative (REZUM®), transuretrale ablative avec assistance robotique (AQUABEAM®) ou endovasculaire par embolisation des arteres prostatiques. Seul l’UROLIFT® est consideree comme une technologie etablie dans les dernieres recommandations de l’EAU. Les quatre autres sont en cours d’evaluation et des recommandations europeennes n’ont ete emises uniquement pour deux d’entre eux, l’AQUABEAM® et l’embolisation des arteres prostatiques. Conclusion Ces nouvelles techniques mini-invasives ont pour but d’augmenter les options therapeutiques pour la prise en charge de l’HBP afin de proposer une prise en charge plus adaptee aux souhaits du patient. Certaines se positionnent en alternative au traitement chirurgical, d’autres a la place du traitement medical ou entre le traitement medical et chirurgical. Ces technologies ne sont pas toutes au meme niveau de developpement, d’evaluation et de niveau de preuve mais ont en commun une diffusion restreinte en France, compte tenu notamment de leur cout. Leur utilisation au sein d’etudes validees permettra de positionner leur utilisation ulterieure de facon plus precise.
Published: 2021
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27. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation

Author: Enrique Rijo, Romain Mathieu, Vincent Misrai, Benoit Peyronnet, Zine-Eddine Khene, Benjamin Pradere, Karim Bensalah, Sonia Guérin, Morgan Rouprêt, and A. Gasmi
Subjects: Male, Nephrology, medicine.medical_specialty, Urology, Enucleation, Prostatic Hyperplasia, 030232 urology & nephrology, 03 medical and health sciences, 0302 clinical medicine, International database, Prostate, Internal medicine, medicine, Humans, Propensity Score, Aged, Retrospective Studies, business.industry, Incidence (epidemiology), Transurethral Resection of Prostate, technology, industry, and agriculture, Perioperative, Middle Aged, Treatment Outcome, medicine.anatomical_structure, Greenlight laser, 030220 oncology & carcinogenesis, Propensity score matching, Laser Therapy, business
Abstract: To compare the perioperative and functional outcomes between 180_W XPS GreenLight photoselective vaporization (PVP) and 532-nm GreenLight laser enucleation of the prostate (GreenLEP) in the surgical management of benign prostatic obstruction (BPO). Retrospective review of a prospectively maintained international database of patients managed with GreenLight laser surgery (PVP or GreenLEP) was performed. To adjust for potential baseline confounders, propensity-score matching (PSM) was applied at a ratio of 1:1 to compare the perioperative and functional outcomes between the groups. A total of 2,420 patients were included. 1,491 (61.6%) underwent PVP and 929 (38.4%) underwent GreenLEP. Before PSM analysis, patients in the vaporization group were older (p
Published: 2021
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28. MP29-05 PROPENSITY-SCORE ANALYSIS COMPARING PERIOPERATIVE AND FUNCTIONAL OUTCOMES BETWEEN XPS 180 W PHOTOVAPORIZATION AND GREENLIGHT LASER ENUCLEATION OF THE PROSTATE: REASONS TO DISCARD VAPORIZATION AND MOVE TO ENUCLEATION

Author: Anis Gasmi, Zine-Eddine Khene, Sonia Guérin, Karim Bensalah, Benoit Peyronnet, Romain Mathieu, Morgan Rouprêt, Enrique Rijo, Benjamin Pradère, and Vincent Misrai
Subjects: Urology
Published: 2022
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29. MP01-18 GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE IN HIGH-MEDICAL-RISK PATIENTS: AN ANALYSIS OF THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

Author: David-Dan Nguyen, Claudia Deyirmendjian, Kyle Law, Naeem Bhojani, Dean Elterman, Bilal Chughtai, Franck Bruyere, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin Zorn
Subjects: Urology
Published: 2022
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30. MP04-01 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON FUNCTIONAL OUTCOMES OF GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE (PVP): AN ANALYSIS OF 3500 MEN IN THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

Author: Iman Sadri, David-Dan Nguyen, Kyle Law, Adel Arezki, David Bouhadana, Naeem Bhojani, Dean Elterman, Ahmed S. Zakaria, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Buenos Aires, null Argentina, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin C. Zorn
Subjects: Urology
Published: 2022
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31. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

Author: Dmitri Nepogodiev, Joana Ff Simoes, Elizabeth Li, Maria Picciochi, James C Glasbey, Glauco Baiocchi, Ruth Blanco-Colino, Daoud Chaudhry, Ehab AlAmeer, Kariem El-Boghdadly, Funmilola Wuraola, Dhruva Ghosh, Rohan R Gujjuri, Ewen M Harrison, Herman Lule, Haytham Kaafarani, Mohammad Khosravi, Irmgard Kronberger, Sezai Leventoğlu, Harvinder Mann, Kenneth A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin Ntirenganya, Lisa Norman, Oumaima Outani, Riinu Pius, Peter Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei Satoi, Catherine Shaw, Aneel Bhangu, Omar M Omar, Waheed-Ul-Rahman Ahmed, Leah Argus, Alasdair Ball, Edward P Bywater, Amanpreet Brar, Brett E Dawson, Irani Duran, Muhammed Elhadi, Conor S Jones, Sivesh K Kamarajah, James M Keatley, Samuel Lawday, Ella J Marson, Riinu Ots, Irène Santos, Elliott H Taylor, Isobel M Trout, Chris Varghese, Mary L Venn, William Xu, Irida Dajti, Arben Gjata, Salah Eddine Oussama Kacimi, Luis Boccalatte, Daniel Cox, Philip Townend, Felix Aigner, Irmgard Elisabeth Kronberger, Elgun Samadov, Amer Alderazi, Kamral Hossain, Greg Padmore, Gabrielle van Ramshorst, Ismaïl Lawani, Anis Cerovac, Samir Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad Gohar, Mihail Slavchev, Chukwuemeka Nwegbu, Arnav Agarwal, Janet Martin, Joshua Ng-Kamstra, Maricarmen Olivos, Wenhui Lou, Dong-Lin Ren, Jose Andres Calvache, Carlos J Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos Gouvas, Jaroslav Klat, René Novysedlák, Nicolas Amisi, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango-Naranjo, Sameh Emile, Danilo Alfonso Arévalo Sandoval, Hailu Dhufera, Samuel Hailu, Mengistu G Mengesha, Joonas H Kauppila, Alexis P Arnaud, Zaza Demetrashvili, Markus Albertsmeier, Hans Lederhuber, Markus W Löffler, Daniel Kwesi Acquah, Bernard Ofori, Stephen Tabiri, Symeon Metallidis, Georgios Tsoulfas, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Tamás Mersich, Dániel Wettstein, Gabriele Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud Mozafari, Ahmed Hilmi, Helen Mohan, Oded Zmora, Gaetano Gallo, Francesco Pata, Gianluca Pellino, Yuki Fujimoto, Naoto Kuroda, Mohamad K Abou Chaar, Faris Ayasra, Ildar Fakhradiyev, Intisar Hisham Said Hamdun, Jang Jin-Young, Mohammad Jamal, Lina Karout, Aiste Gulla, Fanjandrainy Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura Martinez, María José Martínez, Alejandra Nayen, Antonio Ramos-De la Medina, Jade Nunez, Pueya Rashid Nashidengo, Rakesh Shah, Ashish Lal Shrestha, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Deborah Wright, Lukman Abdur-Rahman, Adesoji Ademuyiwa, Adewale Adisa, Babatunde Osinaike, Justina Seyi-Olajide, Omolara Williams, Emmanuel Williams, Sofija Pejkova, Zainab Al Balushi, Raza Sayyed, Mustafa Abo Mohsen, Sadi A Abukhalaf, Moises Cukier, Hugo Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr Major, José Azevedo, Miguel F Cunha, Ahmad Zarour, Eduard-Alexandru Bonci, Ionut Negoi, Sergey Efetov, Viktor Kochetkov, Andrey Litvin, Jc Allen Ingabire, Georges Bucyibaruta, Ntirenganya Faustin, Sosthene Habumuremyi, Alphonsine Imanishimwe, Haragirimana Jean de Dieu, Emmanuel Munyaneza, Isaie Ncogoza, Ehab Alameer, Abdourahmane Ndong, Dejan Radenkovic, Min Hoe Chew, Frederick Koh, James Ngu, Arpád Panyko, Uros Bele, Jurij Aleš Košir, Hassan Daoud, Ana Maria Minaya Bravo, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin Rutegård, Malin Sund, Michel Adamina, Eleftherios Gialamas, Karoline Horisberger, Muhammad Alshaar, Abel Huang, Varut Lohsiriwat, Shane Charles, Haithem Jlassi, Arda Isik, Hervé Monka Lekuya, Slava Kopetskyi, Hayder Alsaadi, Sattar Alshryda, Osaid Alser, Brittany Bankhead-Kendall, Kerry Breen, Hassan Mashbari, Fernando Bonilla Cal, Hamza Al-Naggar, Mayaba Maimbo, Dennis Mazingi, Tom Abbott, Melika Akhbari, Ruth Benson, Shivam Bhanderi, Bruce Biccard, Edward Caruana, Sohini Chakrabortee, Reema Chapatwala, Ainhoa Costas-Chavarri, Andreas K Demetriades, Anant Desai, Salomone Di Saverio, Thomas Drake, John Edwards, Jonathan Evans, Marco Fiore, Samuel Ford, Christina Fotopoulou, Alexander Fowler, Kaori Futaba, Ian Ganly, Harelimana Grace James, Ewen Griffiths, Alessandro Gronchi, Peter Hutchinson, Gabriella Yael Hyman, Joseph Incorvia, Ritu Jain, Michael Jenkinson, Tabassum Khan, Stephen Richard Knight, Angelos Kolias, Søren Kudsk-Iversen, Tsun Yu Kwan, Elaine Leung, Julio Mayol, Siobhan McKay, John G Meara, Emily Mills, Susan Moug, Akshay Patel, Roberto Perinotti, Henry E Rice, Keith Roberts, Andrew Schache, Richard Shaw, Neil Smart, Matthew Stephens, Grant D Stewart, Ella Teasdale, Peter Vaughan-Shaw, Raghavan Vidya, Naomi Wright, Natalie Zimmelman, Ervis Agastra, Dariel Thereska, Sergio Martin Lucchini, Veronica Laudani, Carina Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin Duro, José Alfredo Calderón Arancibia, Giuliana D'Aulerio, Nagendra Dudi-Venkata, Natasha Egoroff, Shebani Farik, Natalie Lott, Jana-Lee Moss, Sarah Rennie, Lorwai Tan, Uyen Giao Vo, David Watson, David Watters, Tim Bright, Paul Hollington, Xuanyu Zhou, Hidde M Kroon, Anthony Farfus, John Barker, Eleanor Watson, Sean Stevens, Haider Latif, Amanda Caroline Dawson, Alwin Chuan, Vijayaragavan Muralidharan, Enoch Wong, Travis Ackermann, Maurizio Pacilli, Russell Hodgson, Alexander Heriot, Peter Choong, Wendy Brown, Surjit Lidder, Justin Yeung, Luke Traeger, Guillermo Regalo, Ralph Gourlay, Sarit Badiani, Cherry Koh, Soni Putnis, Fayza Haider, Ashrarur Rahman Mitul, Niels Komen, Bert Dhondt, Serge Cappeliez, Manon Pigeolet, Martijn Schoneveld, Jasper Stijns, Wouter Oosterlinck, Nicolas Flamey, Cyrille Kpangon, Mouhamed Agbadebo, S Mèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana Makdissi, Suely Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme Yazbek, Stenio C Zequi, Ronald Flumignan, Natalia Jaworska, Angela Dell, Harsha Shanthanna, Abdollah Behzadi, Carolyn Nessim, Michelle Mozel, Pascal St-Germain, Crispin Russell, Gary Groot, Najib Safieddine, Duminda Wijeysundera, Antoine Eskander, Sami Chadi, Shawn MacKenzie, Alana Flexman, Fernando Heredia, Julio Villanueva, Sofia Waissbluth, Roberto Macchiavello, Mario I Escudero, Tyare Fuentes, Ximena Mimica, Dinimo Bolivar Saenz, Lina Caicedo, Juan Pablo Alzate, Joaquin Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana Rodriguez, Liliana Silva-Igua, Martha Luz Torres, Lina María Trujillo, Albaro José Nieto Calvache, Julián Balanta-Melo, Rafael Figueroa-Casanova, Oscar-Julián García-Montoya, Carlos Andres Marulanda Toro, Marcela Velez Botero, Maria Clara Mendoza Arango, Eneida Diaz Martinez, Valentina Gutiérrez Perdomo, Emileth 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Lule, Haytham Kaafarani, Mohammad Khosravi, Irmgard Kronberger, Sezai Leventoğlu, Harvinder Mann, Kenneth A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin Ntirenganya, Lisa Norman, Oumaima Outani, Riinu Pius, Peter Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei Satoi, Catherine Shaw, Aneel Bhangu, Dmitri Nepogodiev, Omar M Omar, Waheed-Ul-Rahman Ahmed, Leah Argus, Alasdair Ball, Aneel Bhangu, Edward P Bywater, Ruth Blanco-Colino, Amanpreet Brar, Daoud Chaudhry, Brett E Dawson, Irani Duran, Muhammed Elhadi, James C Glasbey, Rohan R Gujjuri, Conor S Jones, Ewen M Harrison, Sivesh K Kamarajah, James M Keatley, Samuel Lawday, Elizabeth Li, Harvinder Mann, Ella J Marson, Kenneth A Mclean, Dmitri Nepogodiev, Lisa Norman, Riinu Ots, Oumaima Outani, Maria Picciochi, Irène Santos, Catherine Shaw, Joana Ff Simoes, Elliott H Taylor, Isobel M Trout, Chris Varghese, Mary L Venn, William Xu, Joana Ff Simoes, Irida Dajti, Arben Gjata, Salah Eddine Oussama Kacimi, Luis Boccalatte, Maria Marta Modolo, Daniel Cox, Peter Pockney, Philip Townend, Felix Aigner, Irmgard Elisabeth Kronberger, Elgun Samadov, Amer Alderazi, Kamral Hossain, Greg Padmore, Gabrielle van Ramshorst, Ismaïl Lawani, Anis Cerovac, Samir Delibegovic, Glauco Baiocchi, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad Gohar, Mihail Slavchev, Chukwuemeka Nwegbu, Arnav Agarwal, Amanpreet Brar, Janet Martin, Joshua Ng-Kamstra, Maria Marta Modolo, Maricarmen Olivos, Wenhui Lou, Dong-Lin Ren, Jose Andres Calvache, Carlos J Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos Gouvas, Jaroslav Klat, René Novysedlák, Nicolas Amisi, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango-Naranjo, Sameh Emile, Danilo Alfonso Arévalo Sandoval, Hailu Dhufera, Samuel Hailu, Mengistu G Mengesha, Joonas H Kauppila, Alexis P Arnaud, Zaza Demetrashvili, Markus Albertsmeier, Hans Lederhuber, Markus W Löffler, Daniel Kwesi 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Wilberforce M Kabweru, Hervé Monka Lekuya, Ronald Kiweewa, Herman Lule, Paul Matovu, Otolia Isaac, Mohamed Mashhour, Amin El Helw, Sattar Alshryda, Safeena Kherani, Awadelkarim Mohamed, Ferial Mohamed Ali Abbas, Diary Mohammed, Ehab Aldlyami, Rakesh Kundra, Mohamed Mashhour, Mohamed Mashhour, Antony Louis Rex Michael, Hayder Alsaadi, Kareem S Khalil, Rachel Dbeis, Shafaque Shaikh, Jenny Ferry, Aiman Jamal, Haleema Siddique, Rishi Das, Nikhil Ponugoti, Sivesh K Kamarajah, Pornjittra Rattanasirivilai, Asma Sultana, Frances Mosley, Matthew Chan, Antony Bateman, Gareth Davies-Jones, Fanourios Georgiades, Grant D Stewart, Navid Ahmadi, Aman Coonar, Mariam Baig, Chetan Khatri, Arthika Surendran, Julian Sonksen, Robert Sinnerton, Caitlin Brennan, Gemma Faulkner, Michael Greenhalgh, Hannah Emerson, Kiran Singisetti, Joshua Totty, Michael Wilson, Terence Lo, Harriet Corbett, Ijeoma Okonkwo, Gill Arbane, Kariem El-Boghdadly, Cyrus Kerawala, Chetan Parmar, Tom Abbott, Michael Bath, Funlayo Odejinmi, Jayesh Sagar, Rishi Talwar, Samuel Newman, John Hammond, John Moir, Natalie Duric, Tamas Szakmany, Ahmar Iftikhar Talib, Mina Youssef, Christopher Lewis-Lloyd, Christopher Lewis-Lloyd, Mariam Lami, Khurram Ayub, Benjamin Dean, Supriya Balasubramanya, Sathya Lakpriya, Luke Rogers, Paul Turner, Mark Maher, Kohila Sigamoney, John Edwards, Jihène El Kafsi, John Hardie, David Johnson, Christin Henein, Marianne Hollyman, Ketan Agarwal, Simon Powell, Govind Singh Chauhan, Rakesh Patel, Joel Gagnier, Heather Carmichael, Aurora, Kristofor A Olson, Eric Etchill, Joseph Incorvia, Sameer Hirji, Matthew Naunheim, Frederick Drake, Haytham Kaafarani, Caroline Reinke, Anna Alecci, Dennis Vaysburg, Jennifer Rodriquez, Emily Shih, Vin Shen Ban, Julia Coleman, Henry E Rice, Krista Kaups-Fresno, Emmanouil Giorgakis, Maggie DiNome, Neal Bhutiani, Omar Alnachoukati, Brittany Bankhead-Kendall, Taylor Aiken, Thomas Diehl, Ankush Gosain, Rishi Rattan, Muhammad Owais Abdul Ghani, Nensi Melissa Ruzgar, Anna Liveris, Nina Glass, Charu Paranjape, Theresa Chin, Antonio Meola, Kristina Nicholson, John Squiers, Stephanie Lueckel, Janani Reisenauer, Rachael Callcut, Ahmed Mansour, Allison Berndtson, Lucy Kornblith, Sara Seegert, Paulo Martins, Hamza Al-Naggar, Mohammed Al-Shehari, Ibrahim Al-Raimi, Allan Ngulube, Maphios Siamuchembu, Willard Mushiwokufa, Busisiwe Mlambo, Simbarashe Chinyowa, Ervis Agastra, Enton Bollano, Kostandin Gjyli, Dariel Thereska, Irida Dajti, Jola Kerpaci, Enxhi Vrapi, Lorena Zijaj, Bahraoui Djahida, Belabbes Fatima Zohra, Kouidri Khadidja, Oussama Bali, Nassim Benallel, Ismahene Lalmi, Meriem Abdoun, Nesrine Aouabed, Souad Bouaoud, Kamel Bouchenak, Assia Haif, Zineddine Soualili, Joaquin Bastet, Agustín Bianco, Daniel Capitaine, Jorge Centeno Lozada, Carlos Esquivel, Rodrigo Figueroa, Manuel Garcia, Pablo Martín García, José Ignacio Gerchunoff, Fernando Martinez Iascano, Jose Mondino, María Emilia Muriel, Carmignani Pablo, Martin Passadore, Alejandra Tornini, Rogelio Traverso, Lara Vargas, Gerardo Zanoni, Norberto Berber, Estefanía Cotta, Marcela Di Vincenzo, Esteban Sebastian Gallino, Cecilia Gigena, Bianca Grassano, Veronica Laudani, Ignacio Lugones, Constanza Madrid, Maximiliano Maricic, Antonio Alberto Martinez, Andres Rosso, Pablo Scher, Sofia Tachella, Damaris Idara Anabel Zezular, Carla Abuawad, Agustin Albani Forneris, Carola Allemand, Laura Gisela Alvarez Calzaretta, Luis Boccalatte, Jorge G Boretto, Rocio Boudou, Rodrigo Brandariz, Martin Buljubasich, Arturo Burchakchi, Martin Buttaro, Juan Pablo Campana, Virginia Cano Busnelli, Tomas Carminatti, Agustina Florencia Castro Lalín, Julian Cereghini, María Sol Crespi Amor, Roberto Sebastián Croattini, Maria Sol Fernandez, Marcelo Figari, Uriel Fraidenraij, Diego Gallegos, Agustín Maria García-Mansilla, Marcos Gonzalez, Matias Ignacio Gonzalez, Esteban Gonzalez Salazar, Jeremias Goransky, Guillermo Hernandez Gauna, Felipe Higuera, Fernando Holc, Esteban Gabriel Jauregui, Juan Larrañaga, Juan Liyo, Lionel Llano, Pablo Lobos, Emilia Luzzi, Gustavo Mastroianni, Santiago Miguel Mata-Suarez, Horacio F Mayer, Santiago Mc Loughlin, Efrain Mendoza, Ricardo Esteban Mentz, Pedro Mercado, Pablo Moyano, Florencia Noll, Diego Odetto, Agustina Rene Oliva, Rafael Perez Vidal, Catalina Poggi, Eduardo Jorge Premoli, María Lourdes Ramos, Patricio Rosas, Luciano Rossi, Gustavo Rossi, Jose Saadi, Jordán Scherñuk, Pablo Slullitel, María Verona Stang, María Victoria Taboada, Sebastian Tirapegui, Constanza Uffelmann, Carlos Vaccaro, Roberto Vagni, Ana Clara Valerio, Celeste Soledad Zarratea, Carina Chwat, Silvina Montal, Brian Morris, Pedro Valdez, Fernando Diaz-Couselo,Ricci C, Casadei R, Fruscio, R, Ornaghi, S, Felice Pecoraro, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Vito Chiantera, Mariano Catello Di Donna, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Simoes, J, Rosati, R, on behalf of COVIDSurg Collaborative, GlobalSurg Collaborative, Aldrighetti, L, Mortini, P, Olmi, S, Medical Oncology, Assoc Surg Training ASiT, European Soc Coloproctology ESCP, EuroSurg, G4 Alliance, GlobalPaedSurg, GICS, ItSURG, ISRC, Italian Soc Colorectal Surg SICCR, PTSurg, S-ECCO, South African Soc, and SpainSurg
Subjects: Lung Diseases, Male, Internationality, SARS-Cov-2, COVID-19, surgery, pathways, pre-operative isolation, Settore MED/18 - CHIRURGIA GENERALE, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Lung Disease, ESTUDOS PROSPECTIVOS, Cohort Studies, Patient Isolation, Postoperative Complications, 80 and over, Prospective Studies, Prospective cohort study, 610 Medicine & health, Aged, 80 and over, Incidence (epidemiology), Treatment Outcome, Elective Surgical Procedures, Female, Elective Surgical Procedure, Cohort study, Human, medicine.medical_specialty, Isolation (health care), Preoperative care, NO, Anesthesiology, Preoperative Care, medicine, Humans, Elective surgery, LS7_4, Aged, business.industry, pathway, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Prospective Studie, Anesthesiology and Pain Medicine, Human medicine, Postoperative Complication, Cohort Studie, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
Published: 2021
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32. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials

Author: Dean Elterman, Naeem Bhojani, Vincent Misrai, Faysal A. Yafi, Kevin C. Zorn, Bilal Chughtai, and Enrique Rijo
Subjects: Male, medicine.medical_specialty, Urology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Prostatic Hyperplasia, 030232 urology & nephrology, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Lower Urinary Tract Symptoms, Humans, Medicine, Reproductive health, Transurethral resection of the prostate, 030219 obstetrics & reproductive medicine, Modalities, United States Food and Drug Administration, business.industry, Penile Erection, Transurethral Resection of Prostate, Obstetrics and Gynecology, Hyperplasia, medicine.disease, United States, Clinical trial, Psychiatry and Mental health, Sexual dysfunction, Reproductive Medicine, medicine.symptom, business, Sexual function
Abstract: Introduction Traditional benign prostatic hyperplasia treatment options, such as transurethral resection of the prostate and laser, have focused on addressing urinary symptoms for men; however, these options are associated with a high risk of sexual dysfunction. Objective The objective of this study was to assess newer technologies (Aquablation therapy, UroLift, and Rezum) for the treatment of benign prostatic hyperplasia and the impact of preserving sexual function compared with transurethral resection of the prostate. Methods A comprehensive review of Food and Drug Administration randomized studies from each of the technologies was carried out. A comparison of 3-year outcomes for International Index of Erectile Function-5 and Male Sexual Health Questionnaire Ejaculatory Function domain short form was analyzed. Results Aquablation and prostatic urethral lift were the only therapies to show permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. Conclusion For prostates less than 80 cc, Aquablation and prostatic urethral lift were able to demonstrate permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. Bhojani N, Yafi FA, Misrai V, et al. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2021;9:169–173.
Published: 2021
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33. Multicenter experience with photoselective vaporization of the prostate on men taking novel oral anticoagulants

Author: Henry H. Woo, Shahin Tabatabaei, Vincent Misrai, and Brooke Sachs
Subjects: medicine.medical_specialty, Photoselective vaporisation of the prostate, Urinary system, 030232 urology & nephrology, Non-vitamin K oral anticoagulants, lcsh:RC870-923, 03 medical and health sciences, 0302 clinical medicine, Prostate, medicine, Benign prostatic hyperplasia, business.industry, Warfarin, technology, industry, and agriculture, Perioperative, Clopidogrel, lcsh:Diseases of the genitourinary system. Urology, Surgery, Discontinuation, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Original Article, Photoselective vaporization, Prostatic obstruction, Benign prostatic obstruction, business, medicine.drug, Novel oral anticoagulants
Abstract: Objective Photoselective vaporization of the prostate (PVP) is a widely performed surgical procedure for benign prostatic obstruction. This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants (NOACs). This study was to examine the perioperative outcomes in men on NOACs undergoing PVP, with particular reference to perioperative morbidity. Methods A retrospective analysis of PVP datasets was undertaken from three centres in Sydney (Australia), Toulouse (France) and Boston (USA). Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified. Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo (CD) classification. Results There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period. The mean age was 77 ± 6.5 years. The mean prostate volume, energy utilization and vaporisation time was 94 ± 56 mL, 301 ± 211 kJ, and 35 ± 21 min respectively. The mean postoperative duration of catheterization and duration of hospitalization was 2.2 ± 2.4 days and 2.4 ± 2.4 days respectively. There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions. Conclusions This study supports the safety of men on NOACs undergoing PVP. Whilst this study represents the largest experience of PVP in these men, larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.
Published: 2020

34. Systematic review of the endoscopic enucleation of the prostate learning curve

Author: Enrique Rijo, Svetlana Gabdullina, Andrey Morozov, Alexei Podoinitsin, Mark Taratkin, Thomas R. W. Herrmann, Vincent Misrai, and Dmitry Enikeev
Subjects: Male, Prostatectomy, medicine.medical_specialty, business.industry, Urology, Enucleation, Significant difference, Prostate, 030232 urology & nephrology, Endoscopy, Common method, 03 medical and health sciences, 0302 clinical medicine, Greenlight laser, Learning curve, 030220 oncology & carcinogenesis, Clinical endpoint, Humans, Medicine, Medical physics, Experience level, business, Learning Curve, Systematic search
Abstract: It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30–40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150–200 cases. TUEB required roughly 40–50 cases to reach the plateau. Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30–50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning.
Published: 2020
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35. Reasons to overthrow TURP: bring on Aquablation

Author: David-Dan Nguyen, Enrique Rijo, Ahmed S. Zakaria, Claus G. Roehrborn, Iman Sadri, Thorsten Bach, Russell N Schwartz, Kevin C. Zorn, Adel Arezki, Félix Couture, Dean Elterman, and Vincent Misrai
Subjects: medicine.medical_specialty, Prostatectomy, business.industry, Urology, medicine.medical_treatment, Enucleation, 030232 urology & nephrology, Holmium laser, Prostatic enlargement, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Prostate, 030220 oncology & carcinogenesis, medicine, Operative time, business, Transurethral resection of the prostate
Abstract: In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE). A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion. For small–medium prostates (30–80 mL), Aquablation’s main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80–150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern. The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.
Published: 2020
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36. Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP

Author: Naeem Bhojani, David-Dan Nguyen, Thorsten Bach, James E. Lingeman, Kevin C. Zorn, Dean Elterman, and Vincent Misrai
Subjects: medicine.medical_specialty, business.industry, Urology, Enucleation, 030232 urology & nephrology, Holmium laser, Prostate size, Resection, 03 medical and health sciences, Small prostate, 0302 clinical medicine, medicine.anatomical_structure, Prostate, 030220 oncology & carcinogenesis, medicine, Operative time, business, Procedure time
Abstract: The BPH surgical armamentarium is composed of a rapidly expanding number of technologies and techniques. These include greenlight photovaporization of the prostate (PVP), greenlight enucleation of the prostate (GreenLEP), holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP) and, more recently, the aquablation procedure. To the best of our knowledge, no direct comparison in operative time has been performed. Data for this study were pooled from five sources. For aquablation, patient-level data from four studies of the aquablation procedure were provided by the device manufacturer as well as from a high-volume commercial user. PVP, GreenLEP, HoLEP, and ThuLEP were performed by high-volume, experienced experts. Endpoints included total operative time, resection time, and proportion of total operative time for resection. General linear models were used to evaluate the relationship between prostate volume (or other continuous predictors) and procedure time. Total procedure time was related to prostate size. Except for the small prostate size range (size 40 cc.
Published: 2020
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37. Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database

Author: Aurelie Mailhac, Albert El-Hajj, Nassib Abou Heidar, Vincent Misrai, Hani Tamim, and Muhieddine Labban
Subjects: Male, Nephrology, medicine.medical_specialty, Databases, Factual, Urology, Urinary system, medicine.medical_treatment, education, Enucleation, Prostatic Hyperplasia, 030232 urology & nephrology, urologic and male genital diseases, Logistic regression, computer.software_genre, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Prostate, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Transurethral resection of the prostate, Aged, 80 and over, Prostatectomy, Database, business.industry, Transurethral Resection of Prostate, Perioperative, Middle Aged, Quality Improvement, Acs nsqip, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Laser Therapy, business, computer
Abstract: To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47–0.58) times the odds of a LOS > 1 day and 0.67 (0.54–0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.
Published: 2020
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38. Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP

Author: Dmitry Enikeev, Mark Taratkin, Diana Babaevskaya, Andrey Morozov, Vladislav Petov, Roman Sukhanov, Evgeny Shpot, Vincent Misrai, Denis Chinenov, Mikhail Enikeev, and Thomas Herrmann
Subjects: Male, Postoperative Complications, Treatment Outcome, Urology, Thulium, Prostatic Hyperplasia, Quality of Life, Transurethral Resection of Prostate, Humans, Laser Therapy, Lasers, Solid-State, Prospective Studies
Abstract: To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP).This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS 20 or Qmax 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected.Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54).The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
Published: 2022

39. Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitudes, and practices survey

Author: Bryan Kwun-Chung Cheng, Steffi Kar-Kei Yuen, Daniele Castellani, Marcelo Langer Wroclawski, Hongda Zhao, Mallikarjuna Chiruvella, Wei-Jin Chua, Ho-Yee Tiong, Yiloren Tanidir, Jean de la Rosette, Enrique Rijo, Vincent Misrai, Amy Krambeck, Dean S. Elterman, Bhaskar K. Somani, Jeremy Yuen-Chun Teoh, Vineet Gauhar, and Kwun-Chung Cheng B., Kar-Kei Yuen S., Castellani D., Wroclawski M. L., Zhao H., Chiruvella M., Chua W., Tiong H., TANIDIR Y., Rosette J. d. l., et al.
Subjects: Internal Diseases, Urology, Temel Tıp Bilimleri, Bladder outlet obstruction, Sağlık Bilimleri, Genel Tıp, Fundamental Medical Sciences, İç Hastalıkları, Clinical Medicine (MED), TIP, GENEL & DAHİLİ, Benign prostate hyperplasia, UROLOGY & NEPHROLOGY, Health Sciences, Klinik Tıp (MED), ÜROLOJİ VE NEFROLOJİ, MEDICINE, GENERAL & INTERNAL, Internal Medicine Sciences, Klinik Tıp, Dahili Tıp Bilimleri, General Medicine, CLINICAL MEDICINE, Tıp, Nefroloji, Nephrology, Üroloji, Medicine, Surgery, Minimal invasive surgical therapy
Abstract: © 2022 Editorial Office of Asian Journal of UrologyObjective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitude, and practices for benign prostatic obstruction surgeries. Methods: A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitude and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were \"agree or strongly agree\" and less than or equal to 15% responses were \"disagree or strongly disagree\" (consensus agree), or when more than or equal to 70% responses were \"disagree or strongly disagree\" and less than or equal to 15% responses were \"agree or strongly agree\" (consensus disagree). Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regards to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regards to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion: Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.
Published: 2022

40. GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database

Author: David-Dan Nguyen, Claudia Deyirmendjian, Kyle Law, Naeem Bhojani, Dean S. Elterman, Bilal Chughtai, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, and Kevin C. Zorn
Subjects: Male, Treatment Outcome, Urology, Prostate, Prostatic Hyperplasia, Quality of Life, Transurethral Resection of Prostate, Humans, Laser Therapy, Retrospective Studies
Abstract: We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database.Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p 0.01).We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.
Published: 2021

41. Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate

Author: Isabel Lichy, Kyle Law, Côme Tholomier, David-Dan Nguyen, Iman Sadri, David Bouhadana, Félix Couture, Ahmed S. Zakaria, Naeem Bhojani, Kevin C. Zorn, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago J. Borelli-Bovo, Edgardo F. Becher, Vincent Misrai, Dean Elterman, Maximilian Reimann, and Hannes Cash
Subjects: Male, Treatment Outcome, Urology, Prostate, Prostatic Hyperplasia, Humans, Laser Therapy, Volatilization, Aged
Abstract: Purpose To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. Methods 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011–2019) and prostate volume (PV) group ( 150 ml). Results The median age was 70 years (interquartile range 64–77), the median PV was 64 ml (IQR 47–90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45–83) and LT was 33 min (IQR 23–46). Median energy use was 253 kJ (IQR 170–375) with an energy density of 3.94 kJ/ml (IQR 2.94–5.02). The relative probability of perioperative AEs decreased by 17% each year (p p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). Conclusion These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
Published: 2021

42. Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes

Author: Dean, Elterman, Shaun, Shepherd, Seyed Hossein, Saadat, Mark N, Alshak, Naeem, Bhojani, Kevin C, Zorn, Enrique, Rijo, Vincent, Misrai, Katherine, Lajkosz, and Bilal, Chughtai
Subjects: Male, Steam, Treatment Outcome, Lower Urinary Tract Symptoms, Prostate, Prostatic Hyperplasia, Quality of Life, Humans, Minimally Invasive Surgical Procedures, Middle Aged
Abstract: Half of men aged60 years will develop benign prostatic hyperplasia (BPH) with 40% of these men having moderate-to-severe lower urinary tract symptoms (LUTS). There is limited knowledge on a head-to-head comparison of prostatic urethral lift (UroLift) and convective water vapor ablation (Rezum) for the treatment of LUTS secondary to BPH. We sought to compare randomized controlled trials with 3-year clinical outcome data.After a thorough literature search, two multicenter sham-controlled double-blind randomized trials for UroLift and Rezum were identified and compared. Both studies had similar designs, baseline characteristics, reported outcomes, and low risks of bias.Rezum and UroLift resulted in significant improvement of International Prostate Symptom Score (IPSS) at 3 months (51.4% and 49.9%, respectively) and 50% reduction of IPSS Quality of Life that was durable across all time points. At 24 and 36 months, there was a statistically significant difference in IPSS between groups, favoring Rezum (-11.2 ± 7.3 versus -9.13 ± 7.62, p = 0.04, and -11.0 ± 7.1 versus -8.83 ± 7.41, p = 0.04, respectively). While Rezum had greater improvement in Qmax at 3 months (6.4 ± 7.2 versus 4.29 ± 5.16, p0.01), there was no difference in improvement from 12-36 months between treatments. Only UroLift experienced improvements of Men's Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EjD) function from baseline and was better than Rezum at all time points (p0.01). Rezum failed to significantly reduce the MSHQ-EjD bother at 3 months, while UroLift demonstrated a significant reduction of 27.56% (p0.01). Both systems offered equal improvements in the bother score by 12-36 months. Surgical re-treatment rates favored Rezum over Urolift (4.4% vs. 10.7%, respectively).Rezum achieved a greater improvement in symptom relief compared to UroLift. Improvement in ejaculatory dysfunction in patients treated with UroLift was greater than Rezum.
Published: 2021

43. MP09-01 THE AQUABLATION SURGICAL TECHNIQUE LEARNING CURVE: A MULTICENTER STUDY

Author: Enrique Rijo, Jad Najdi, Albert El Hajj, Muhieddine Labban, Vincent Misrai, and Ali A. Nasrallah
Subjects: medicine.medical_specialty, Multicenter study, business.industry, Urology, Medicine, Medical physics, business
Published: 2021
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44. MP01-11 POOLED ANALYSIS OF BLADDER FUNCTION POST-AQUABLATION

Author: Alexis E. Te, Peter J. Gilling, Mihir M. Desai, Claus G. Roehrborn, Naeem Bhojani, Dean Elterman, Vincent Misrai, Mitch Humphreys, Thorsten Bach, Neil Barber, Kevin C. Zorn, and Steven Kaplan
Subjects: Procept, medicine.medical_specialty, Robotic systems, Pooled analysis, Biorobotics, business.industry, Urology, Ablative case, Medicine, business, Bladder function, Surgery
Abstract: INTRODUCTION AND OBJECTIVE:Aquablation Therapy (AQUABEAM Robotic System, PROCEPT BioRobotics, Inc., USA) is an ultrasound-guided, robotically executed waterjet ablative procedure used to treat men ...
Published: 2021
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45. MP01-20 A STANDARDIZED METHOD FOR ESTIMATING THE CARBON FOOTPRINT OF DISPOSABLE MINI-INVASIVE SURGICAL DEVICES: APPLICATION IN TRANSURETHRAL PROSTATE SURGERY

Author: Naeem Bhojani, Thomas R. W. Herrmann, Vincent Misrai, Grégoire Robert, Benjamin Pradere, Enrique Rijo, Alexandre de la Taille, Dean Elterman, Dmitry Enikeev, and Kevin C. Zorn
Subjects: Mini invasive surgery, business.industry, Urology, Carbon footprint, Medicine, Prostate surgery, Operations management, business
Abstract: INTRODUCTION AND OBJECTIVE:The healthcare sector accounts for 4.4% of the annual human-induced CO2 net emissions (CO2e). Operating rooms are facing the arrival of a plethora of disposable mini-inva...
Published: 2021
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46. Editorial: Lower urinary tract symptoms, benign prostate hyperplasia and beyond

Author: Shahrokh F. Shariat, Dmitry Enikeev, and Vincent Misrai
Subjects: Male, medicine.medical_specialty, Hyperplasia, business.industry, Urology, Prostatic Hyperplasia, medicine.disease, Lower Urinary Tract Symptoms, Lower urinary tract symptoms, Medicine, Humans, business, Benign prostate
Published: 2021

47. Transfusion rates after 800 Aquablation procedures using various haemostasis methods

Author: Kevin C. Zorn, Naeem Bhojani, Enrique Rijo, Mihir M. Desai, Dean Elterman, Vincent Misrai, Thorsten Bach, Bilal Chughtai, Albert El Hajj, and Paul Anderson
Subjects: Ablation Techniques, Male, robotic, medicine.medical_specialty, Blood transfusion, Urology, medicine.medical_treatment, Prostatic Hyperplasia, 030232 urology & nephrology, Aquablation therapy, 03 medical and health sciences, 0302 clinical medicine, Lower urinary tract symptoms, Prostate, medicine, Humans, Blood Transfusion, lower urinary tract symptoms, Retrospective Studies, Prostatectomy, Robotics & Laparoscopy, benign prostatic hyperplasia, Hemostatic Techniques, transfusions, business.industry, Water, Retrospective cohort study, medicine.disease, Surgery, Neck of urinary bladder, Catheter, medicine.anatomical_structure, 030220 oncology & carcinogenesis, business, Open Prostatectomy
Abstract: INTRODUCTION AND OBJECTIVE: Prostate tissue resection for patients with lower urinary tract symptoms (LUTS) remains the most effective means to provide symptomatic improvement. Many studies have evaluated the bleeding complication profile post-operatively for TURP and report a range up to 7% of patients requiring a blood transfusion, but with typical limitations in treating prostates up to 80mL in size. For larger prostates (>80mL), open prostatectomy and Holmium laser enucleation of the prostate (HOLEP) are the global reference standard surgical options with reported transfusion rates up to 24% and 4%, respectively. The Aquablation procedure is a new, impressively fast, resective BPH surgical alternative harnessing image guidance, high velocity waterjet, and robotic standardized execution, with a rapid learning curve. While several techniques for hemostasis following Aquablation have been utilized, the optimal strategy has not been fully vetted across different prostate sizes. METHODS: The current commercial AQUABEAM robot that performs Aquablation Therapy was first used in 2014. Since then numerous clinical studies have been conducted in various countries; Australia, Canada, Germany, India, Lebanon, Spain, New Zealand, United Kingdom, and the United States. All of the clinical trial data since 2014 have been pooled with the early commercial procedures from France, Germany, and Spain. The objective is to determine if athermal methods are as effective in preventing blood transfusions as the use of cautery across various prostate volume sizes. RESULTS: 801 patients were treated with Aquablation Therapy from 2014 to early 2019. The average prostate volume was 67mL ± 33mL (range 20-280mL) where 31 (3.9%) transfusions were reported. The largest contributing factor to transfusion risk was prostate size and method of traction. There was an increasing risk of transfusions in larger prostates when robust traction using a catheter tensioning device without cautery ranging from 0.8% to 7.8% in prostates ranging from 20mL to 280mL. However, when standard traction (taping the catheter to the leg, gauze knot synched up to the meatus, or no traction at all) was used and where the surgeon performed bladder neck cautery only when necessary, the risk of transfusion 1.4% to 2.5% in prostates ranging from 20mL to 280mL. CONCLUSIONS: While the athermal subgroup with robust traction with a catheter tension device had comparable transfusion rates for smaller prostates, the risk increased significantly as prostate volume increased. With standard traction methods and selective bladder neck cautery, the risk of transfusion is reduced to a 1.9% across all prostate sizes.
Published: 2020
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48. Waterjet Ablation Therapy for Treating Benign Prostatic Obstruction in Patients with Small- to Medium-size Glands: 12-month Results of the First French Aquablation Clinical Registry

Author: Enrique Rijo, Aurélien Descazeaud, Vincent Misrai, Kevin C. Zorn, and Nicolas Barry-Delongchamps
Subjects: Ablation Techniques, Male, medicine.medical_specialty, Adenoma, Urology, Operative Time, Prostatic Hyperplasia, 030232 urology & nephrology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Lower Urinary Tract Symptoms, Prostate, medicine, Clinical endpoint, Humans, Registries, Aged, business.industry, Recovery of Function, Robotics, Perioperative, Length of Stay, Middle Aged, medicine.disease, Confidence interval, Surgery, Treatment Outcome, Erectile dysfunction, medicine.anatomical_structure, 030220 oncology & carcinogenesis, International Prostate Symptom Score, France, Prostatic obstruction, business
Abstract: Background Aquablation has emerged as a novel ablative therapy combining image guidance and robotics for targeted waterjet adenoma resection. Objective To describe a standardised technique of aquablation in the treatment of benign prostatic obstruction (BPO), and to report the perioperative and 1-yr functional outcomes obtained by multiple surgeons with no previous experience of the technique. Design, setting, and participants Between September 2017 and January 2018, patients referred to three different urological centres for BPO surgical management were prospectively enrolled to undergo an aquablation procedure. Surgical procedure Aquablation was performed using the Aquabeam system (Procept BioRobotics, Redwood Shores, CA, USA) that combines transrectal prostatic image guidance and robotics bespoke tissue resection with a high-pressure saline jet. The surgeon defines the area of treatment, and the resection is executed automatically. Measurements The primary endpoint was the change in total International Prostate Symptom Score (IPSS) score at 6 and 12 mo. Functional outcomes were assessed at 1, 3, 6, and 12 mo with IPSS, International Index of Erectile Function (IIEF)-15, Sexual Health Inventory for Men, and Male Sexual Health Questionnaire questionnaires and uroflowmetry. Results and limitations Thirty patients were enrolled in the study. The median operative time and resection time were 30.5 (24–35) and 4 (3.1–4.9) min, respectively. The median catheterisation time was 43 (23–49) h. The median hospitalisation stay was 2 (2–4) d. The IPSS score improved to 3 (1–6) at the 6 mo, with a mean change of 15.6 points (95% confidence interval 13–18.2). IPSS improvements persisted at month 12. The maximum urinary flow rate improved to 20.4 (17–26) ml/s at 12 mo. The 6-mo rates of Clavien-Dindo grade 2 and 3 events were 13.3%. There were no reports of incontinence or de novo erectile dysfunction. Postoperative de novo ejaculatory dysfunction was observed in 26.7% of patients. Conclusions This clinical registry confirmed that aquablation was feasible, safe, and effective, and provided immediate good functional results and similar outcomes to those of prior studies despite the lack of surgeons’ previous experience with the technique. Patient summary Aquablation is feasible, safe, and reproducible with promising outcomes for treating benign prostatic enlargement.
Published: 2019
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49. The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature

Author: Alexis E. Te, Malek Meskawi, Kevin C. Zorn, Lesa D. Deonarine, Vincent Misrai, Bilal Chughtai, Ramy Goueli, Dominique Thomas, and Pierre-Alain Hueber
Subjects: medicine.medical_specialty, Population, 030232 urology & nephrology, Urology, lcsh:RC870-923, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Lower urinary tract symptoms, Prostate, Medicine, education, education.field_of_study, Benign prostatic hyperplasia, business.industry, Urinary retention, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Small prostate, Catheter, GreenLight XPS, medicine.anatomical_structure, Photovaporization of the prostate, 030220 oncology & carcinogenesis, Original Article, International Prostate Symptom Score, medicine.symptom, business, Body mass index
Abstract: Objective: Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results: Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p
Published: 2019
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50. Assessment of Learning Curves for 180-W GreenLight XPS Photoselective Vaporisation of the Prostate: A Multicentre Study

Author: Kevin C. Zorn, Claire Bastard, Benjamin Pradere, Morgan Rouprêt, B. Peyronnet, Vincent Misrai, and Pierre-Alain Hueber
Subjects: Male, medicine.medical_specialty, Multivariate analysis, Urology, Operative Time, Prostatic Hyperplasia, 030232 urology & nephrology, Urologic Oncology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Prostate, Clinical endpoint, Humans, Medicine, Aged, Retrospective Studies, Surgeons, business.industry, Retrospective cohort study, Perioperative, Middle Aged, Surgery, Treatment Outcome, medicine.anatomical_structure, Learning curve, 030220 oncology & carcinogenesis, International Prostate Symptom Score, Clinical Competence, Laser Therapy, business, Learning Curve
Abstract: Background The learning curve for photoselective vaporisation of the prostate (PVP) has never been assessed accurately. Objective To compare 180-W GreenLight XPS PVP learning curves for three surgeons with different levels of surgical experience and different institutional backgrounds. Design, setting, and participants A multicentre retrospective study of the first patients treated with PVP by three operators in three different centres ( n =152 in group 1, n =112 in group 2, n =101 in group 3) was conducted. Surgeon 1 had performed >600 PVP procedures (120-W GreenLight HPS laser) since 2007, while surgeons 2 and 3 had no previous experience with GreenLight PVP. Surgeon 1 mainly treats both benign prostatic hyperplasia (BPH) and urologic oncology, surgeon 2 primarily focuses on urologic oncology, and surgeon 3 mostly treats BPH. Surgeon experience was analysed as a continuous variable in terms of consecutive procedures performed. Intervention PVP using a 180-W GreenLight XPS laser. Outcome measurements and statistical analysis The learning curve was analysed in terms of changes over time for the following variables: operative time, the vaporisation time/operative time ratio, and the energy delivered/prostate volume ratio. The primary endpoint was a trifecta of (1) energy delivered >5kJ/ml of prostate, (2) vaporisation time/operative time ratio of 66–80%, and (3) no postoperative complications. Results and limitations Patient baseline characteristics differed significantly among the centres in terms of age, prostate volume, and International Prostate Symptom Score (IPSS). Most perioperative outcomes favoured group 1 over group 3 over group 2. Functional outcomes, such as a decrease in IPSS at 1 mo for the first 50 patients (−15 vs −13.6 vs −13.3; p 0.0001) and an increase in maximum flow at 1 mo for the first 50 patients (+14.2 vs. +7 vs. +9.4; p 0.0001), favoured group 1 over group 3 over group 2. The trifecta achievement rate was significantly higher in group 3 over group 1 over group 2 (26.7% vs 14.4% vs 5.4%; p 0.0001). In multivariate analysis adjusting for age, American Society of Anesthesiologists score, and preoperative prostate volume, the only factors predictive of trifecta achievement were surgeon experience ( p p Conclusions More than 100 PVP procedures were required to reach an intraoperative parameter plateau regardless of surgeon expertise and institutional background. Both surgeon background and expertise seemed to influence perioperative outcomes during the GreenLight XPS PVP learning curve. Patient summary Both surgeon background and expertise seem to influence perioperative outcomes during the learning curve when using a GreenLight XPS laser for photoselective vaporisation of the prostate.
Published: 2019
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