World journal of urology · 2025
A practical approach to overcome challenges in morcellation following minimally invasive laser enucleation of the prostate: suprapubic percutaneous transvesical morcellation.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Barlas Irfan Safak, Yilmaz Mehmet, Aybal Halil Cagri, Duvarci Mehmet, Kutlu Hakan, Guven Selcuk, Tunc Lutfi
Аннотация
OBJECTIVE: To identify the challenges encountered during the morcellation process and to propose an alternative morcellation approach for patients with urethral strictures that preclude transurethral morcellation.
METHODS: A prospective analysis was conducted on 173 patients who underwent Thulium fiber laser prostate enucleation. Suprapubic percutaneous transvesical morcellation (SPTM) was applied in cases where transurethral morcellation was not feasible.
RESULTS: Sixteen patients underwent SPTM, while 157 underwent standard transurethral morcellation. Morcellation times were similar between the SPTM and standard transurethral morcellation groups (p = 0.627). The SPTM group had shorter total operation and enucleation times, smaller prostate volume, lower PSA levels, and reduced morcellation efficiency (p < 0.05). However, hospitalization time was longer, and catheterization time was shorter in the standard group (p < 0.05). Notably, in eighteen patients with unusually tough prostatic tissue, described as a "beach ball," the morcellation phase was significantly more challenging. Patients in the beach ball group undergoing standard transurethral morcellation had longer morcellation times and lower morcellation efficiency compared to those without beach ball (p < 0.05). Additionally, the beach ball group exhibited higher enucleation efficiency, prostate volume, PSA levels, total laser energy values, longer hospitalization, and postoperative catheterization times, as well as prolonged enucleation and total operation times, compared to patients without this condition (p < 0.05). Prostate tissue density, however, did not differ significantly between the two groups (p = 0.071).
CONCLUSIONS: For patients in whom transurethral insertion of a morcellator is not feasible, percutaneous suprapubic insertion provides a practical and safe alternative for completing the morcellation process.
METHODS: A prospective analysis was conducted on 173 patients who underwent Thulium fiber laser prostate enucleation. Suprapubic percutaneous transvesical morcellation (SPTM) was applied in cases where transurethral morcellation was not feasible.
RESULTS: Sixteen patients underwent SPTM, while 157 underwent standard transurethral morcellation. Morcellation times were similar between the SPTM and standard transurethral morcellation groups (p = 0.627). The SPTM group had shorter total operation and enucleation times, smaller prostate volume, lower PSA levels, and reduced morcellation efficiency (p < 0.05). However, hospitalization time was longer, and catheterization time was shorter in the standard group (p < 0.05). Notably, in eighteen patients with unusually tough prostatic tissue, described as a "beach ball," the morcellation phase was significantly more challenging. Patients in the beach ball group undergoing standard transurethral morcellation had longer morcellation times and lower morcellation efficiency compared to those without beach ball (p < 0.05). Additionally, the beach ball group exhibited higher enucleation efficiency, prostate volume, PSA levels, total laser energy values, longer hospitalization, and postoperative catheterization times, as well as prolonged enucleation and total operation times, compared to patients without this condition (p < 0.05). Prostate tissue density, however, did not differ significantly between the two groups (p = 0.071).
CONCLUSIONS: For patients in whom transurethral insertion of a morcellator is not feasible, percutaneous suprapubic insertion provides a practical and safe alternative for completing the morcellation process.