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169,A hundred and seventy A good RCT has revealed in which TUIP can be as successful as TURP for fairly modest BPH ( http://www.selleck.cn/products/PD-0332991.html electrode).174�C179 Numerous RCT of BPH of 40�C55?mL have shown there http://www.selleckchem.com/products/a-1155463.html is a comparable operation time and efficacy between bipolar TURP and conventional TURP,180�C189 with a significantly lower incidence of hyponatremia for the former.180,183,185,188 Long-term follow-up results, including the duration of effect, are still awaited.190,191 Recommendation grade: A HoLEP is applicable regardless of PV and there is sufficient evidence for its effectiveness and the sustainability of efficacy. It is comparable to open surgery or TURP in any aspect, including complications. A holmium laser is irradiated through an endoscopic channel to either resect a prostatic adenoma or to detach an adenoma from the surgical capsule for enucleation (HoLEP). The holmium laser is readily absorbed by water and is capable of cutting, coagulating, and producing shock waves depending on the distance to the target tissue. Normal saline http://www.selleckchem.com/products/cb-5083.html can be used as the irrigation fluid.192�C201 Numerous RCT have compared HoLEP and TURP202�C209 and have demonstrated that HoLEP is associated with a longer operation time (62.1�C94.6 vs 33.1�C73.8?min for HoLEP vs TURP, respectively),204,206,208 less hemorrhage, and significantly a shorter duration of catheterization and hospitalization.203,204 In four RCT of HoLEP compared with open surgery for large prostates (113�C124?mL),210�C213 HoLEP exhibited comparable efficacy and significant superiority to open surgery in terms of blood transfusion rate and the duration of catheterization and hospitalization. The long-term re-treatment rate following HoLEP did not differ significantly compared with TURP or open surgery.192,203 HoLEP can be performed safely in men with a large prostate (>100?mL) and those that are on anticoagulants.193�C195 A few studies advise a higher chance of postoperative urinary incontinence, climaxing problems, as well as urethral stenosis right after HoLEP.193,214 Suggestion quality: N This system is assigned to the lowest risk of hemorrhage and could be executed safely also in huge prostates.