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Browsing by Author "Shelton, T. Max"
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Item Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy(Springer Nature, 2023) Shelton, T. Max; Drake, Connor; Vasquez, Ruben; Rivera, Marcelino; Urology, School of MedicinePurpose of review: This study reviews contemporary literature on RASP and HoLEP to evaluate perioperative outcomes, common complications, cost analytics, and future directions of both procedures. Recent findings: RASP is indicated for prostates > 80 mL, while HoLEP is size-independent. No notable differences were found in operative time, PSA nadir (surrogate for enucleation volume), re-catheterization rates, or long-term durability. Prolonged incontinence and bladder neck contracture rates are low for both surgeries. Patients experience similar satisfaction outcomes and improvements in uroflowmetry and post-void residual volumes. HoLEP demonstrates shorter hospitalizations, lower transfusion rates, lower costs, and higher rates of same-day discharge. RASP offers a shorter learning curve and lower rates of early postoperative urinary incontinence. HoLEP is a size-independent surgery that offers advantages for patients seeking a minimally invasive procedure with the potential for catheter-free same-day discharge. Future directions with single-port simple prostatectomy may offer parity in same-day discharge, but further research is needed to determine broader feasibility.Item The Utility of Tranexamic Acid in Endoscopic Surgeries for Benign Prostatic Hyperplasia(Springer, 2025-05-17) Siron, Nicolas; Dalton, David C.; Rivera, Marcelino; Shelton, T. Max; Urology, School of MedicinePurpose of review: Tranexamic acid (TXA) is an anti-fibrinolytic agent that prevents degradation of fibrin by blocking the ability of plasminogen to bind to fibrin and the proteolytic activity of plasmin. TXA has been proven to be useful in reducing bleeding complications in multiple types of surgery. In this article, we will review the current usage of TXA in endoscopic surgeries for benign prostatic hyperplasia (BPH). Recent findings: The use of TXA for endoscopic BPH surgeries has mainly been studied for transurethral resection of the prostate (TURP). In the clinical trials assessing the use of TXA and TURP, TXA demonstrated reduced intraoperative bleeding independent of administration route. However, this did not consistently translate to reduced hospitalization or catheterization times. Evidence for the use of TXA and holmium laser enucleation of the prostate (HoLEP) has begun to emerge, and to date limited benefit has been demonstrated. This result is likely due to the excellent innate hemostatic control associated with the procedure. However, further studies are required to validate these findings. With recent innovation in new types of endoscopic BPH surgeries, the benefit of TXA during other types of BPH procedures also require more study. Within the context of endoscopic surgeries for BPH, TXA appears to have the most benefit when performing TURP. More evidence is required to conclude on the benefit in other types of BPH surgery including HoLEP.