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Prostatic arterial embolization followed by holmium laser enucleation of the prostate as a planned combined approach for extremely enlarged benign prostate hyperplasia

Urologia Internationalis Aug 25, 2017

Li P, et al. – This research intended to present the initial experience with prostatic arterial embolization (PAE) followed by holmium laser enucleation of the prostate (HoLEP) as a planned combined approach for extremely enlarged benign prostate hyperplasia (BPH), and retrospectively calculating the utility and safety of this novel technique. It has been validated that PAE followed by HoLEP as a planned combined approach can be performed safely, feasibly, and efficiently in patients with extremely enlarged BPH.

Methods
  • Researchers enrolled 24 BPH patients who underwent PAE and subsequent HoLEP.
  • They conducted the PAE procedure under local anesthesia at the supine position with polyvinyl alcohol spherical particles and gelatin sponge particles.
  • They conducted HoLEP 3 months after PAE by the “en–bloc” enucleation technique.
  • They examined clinical data before and 6 months after the procedure.

Results
  • In all 24 patients , PAE and HoLEP were technically successful.
  • In this study, 219 ± 38 mL was the mean prostate volume ; the mean total operative time and enucleation time for HoLEP were 117.8 ± 21.9 and 83.5 ± 15.4 min, respectively; and the mean resected prostate weight was 118.3 ± 20.7 g.
  • There was no transurethral resection of the prostate syndrome during and after HoLEP.
  • The calculated blood loss during HoLEP was 72.1 ± 33.7 mL, and no case required transfusion.
  • It was showed that International Prostate Symptom Score and post void residual volume decreased significantly (24.1 ± 2.84 vs. 13.5 ± 3.39, p < 0.001; 107.1 ± 40.8 vs. 21.8 ± 16.8, p < 0.001, respectively), maximal flow rate increased significantly (6.25 ± 1.42 vs. 17.63 ± 16.56, p < 0.001), and prostatic specific antigen level also decreased after the procedure (9.29 ± 2.28 vs. 4.99 ± 1.35, p < 0.001).
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