Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Urology Reports
Erschienen in: Current Urology Reports 12/2017

01.12.2017 | Benign Prostatic Hyperplasia (K McVary, Section Editor)

Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes

verfasst von: Joseph M. Kuebker, Nicole L. Miller

Erschienen in: Current Urology Reports | Ausgabe 12/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Holmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes.

Recent Findings

New randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting.

Summary

HoLEP can be applied to the majority of patients with BOO from BPH regardless of prostate size, previous operations, or the condition of the detrusor. HoLEP can also be carefully considered in patients requiring anticoagulation or who are undergoing active surveillance for low-risk prostate cancer. Immediate complication rate is low and incontinence is rare. Retrograde ejaculation occurs in approximately 75% patients. Furthermore, the retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures demonstrating its durability.
Literatur
1.
Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993;150:85–9.CrossRefPubMed
2.
Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17:241–6.CrossRefPubMed
3.
Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111–6.CrossRefPubMedPubMedCentral
4.
Chughtai BI, Simma-Chiang V, Lee R, et al. Trends and utilization of laser prostatectomy in ambulatory surgical procedures for the treatment of benign prostatic hyperplasia in New York State (2000-2011). J Endourol. 2015;29:700–6.CrossRefPubMed
5.
Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology. 1996;47:48–51.CrossRefPubMed
6.
McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793–803.CrossRefPubMed
7.
Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64:118–40.CrossRefPubMed
8.
Salonia A, Suardi N, Naspro R, et al. Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology. 2006;68:302–6.CrossRefPubMed
9.
Naspro R, Suardi N, Salonia A, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol. 2006;50:563–8.CrossRefPubMed
10.
Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160–6.CrossRefPubMed
11.
Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170:1270–4.CrossRefPubMed
12.
Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109:408–11.CrossRefPubMed
13.
Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol. 2004;172:1012–6.CrossRefPubMed
14.
Montorsi F, Naspro R, Salonia A, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004;172:1926–9.CrossRefPubMed
15.
•• Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67:1066–96. Meta-analysis of RCTs comparing HoLEP to OP and monopolar TURP. HoLEP demonstrated equal efficacy to OP with fewer complications. HoLEP demonstrated select advantages over TURP in hosptial stay, catheterization, bleeding, and complications. CrossRefPubMed
16.
• Fayad AS, Elsheikh MG, Zakaria T, et al. Holmium laser enucleation of the prostate versus bipolar resection of the prostate: a prospective randomized study. “Pros and Cons”. Urology. 2015;86:1037–41. Contemporary RCT comparing HoLEP to TURP. HoLEP patients experienced less blood loss, shorter catheterization time, higher Q m , and lower symptoms scores at 1 and 12 months. CrossRefPubMed
17.
• Jhanwar A, Sinha RJ, Bansal A, Prakash G, Singh K, Singh V. Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: a prospective randomized study. Urol Ann. 2017;9:45–50. Contemporary RCT comparing HoLEP to TURP. HoLEP patients experienced shorter catheterization time, shorter hospital stay, more tissue resected, and higher Q m at 24 months. CrossRefPubMedPubMedCentral
18.
Humphreys MR, Miller NL, Handa SE, Terry C, Munch LC, Lingeman JE. Holmium laser enucleation of the prostate--outcomes independent of prostate size? J Urol 2008;180:2431–2435; discussion 5.
19.
Shah HN, Sodha HS, Kharodawala SJ, Khandkar AA, Hegde SS, Bansal MB. Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int. 2008;101:1536–41.CrossRefPubMed
20.
Seki N, Tatsugami K, Naito S. Holmium laser enucleation of the prostate: comparison of outcomes according to prostate size in 97 Japanese patients. J Endourol. 2007;21:192–6.CrossRefPubMed
21.
Krambeck AE, Handa SE, Lingeman JE. Holmium laser enucleation of the prostate for prostates larger than 175 grams. J Endourol. 2010;24:433–7.CrossRefPubMed
22.
Matlaga BR, Kim SC, Kuo RL, Watkins SL, Lingeman JE. Holmium laser enucleation of the prostate for prostates of >125 mL. BJU Int. 2006;97:81–4.CrossRefPubMed
23.
Ahyai SA, Chun FK, Lehrich K, et al. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster? J Urol. 2012;187:1608–13.CrossRefPubMed
24.
• El Tayeb MM, Jacob JM, Bhojani N, Bammerlin E, Lingeman JE. Holmium laser enucleation of the prostate in patients requiring anticoagulation. J Endourol. 2016;30:805–9. Large retrospective series describing outcomes of patients undergoing HoLEP on AC vs. controls. Demonstrates feasibility of performing HoLEP on patients requiring AC around or through the time of surgery. CrossRefPubMed
25.
Bishop CV, Liddell H, Ischia J, et al. Holmium laser enucleation of the prostate: comparison of immediate postoperative outcomes in patients with and without antithrombotic therapy. Curr Urol. 2013;7:28–33.CrossRefPubMedPubMedCentral
26.
Tyson MD, Lerner LB. Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol. 2009;23:1343–6.CrossRefPubMed
27.
Elzayat E, Habib E, Elhilali M. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol. 2006;175:1428–32.CrossRefPubMed
28.
Mitchell CR, Mynderse LA, Lightner DJ, Husmann DA, Krambeck AE. Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: results of a prospective trial. Urology. 2014;83:428–32.CrossRefPubMed
29.
•• Lomas DJ, Krambeck AE. Long-term efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity or acontractility. Urology. 2016;97:208–11. Retrospective study reporting long-term outcomes of patients with DUA or acontractility after HoLEP. Eleven of 15 men who were in retention preop remained catheter-free with mean follow-up of 50 months. CrossRefPubMed
30.
Cho MC, Ha SB, Park J, et al. Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Urology. 2016;91:158–66.CrossRefPubMed
31.
• Kobayashi S, Yano M, Nakayama T, Kitahara S. Predictive risk factors of postoperative urinary incontinence following holmium laser enucleation of the prostate during the initial learning period. Int Braz J Urol. 2016;42:740–6. Reviewed predictors of postoperative UI after HoLEP in 203 patients with preoperative UDS. DO did not predict UI after HoLEP except immediately after catheter removal in cases by novice surgeons. No variable studied predicted UI by experienced surgeons. CrossRefPubMedPubMedCentral
32.
Nam JK, Kim HW, Lee DH, Han JY, Lee JZ, Park SW. Risk factors for transient urinary incontinence after holmium laser enucleation of the prostate. World J Mens Health. 2015;33:88–94.CrossRefPubMedPubMedCentral
33.
Shigemura K, Tanaka K, Yamamichi F, Chiba K, Fujisawa M. Comparison of predictive factors for postoperative incontinence of holmium laser enucleation of the prostate by the surgeons’ experience during learning curve. Int Neurourol J. 2016;20:59–68.CrossRefPubMedPubMedCentral
34.
Briganti A, Naspro R, Gallina A, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol. 2006;175:1817–21.CrossRefPubMed
35.
Elshal AM, Elmansy HM, Elkoushy MA, Elhilali MM. Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology. 2012;80:1098–104.CrossRefPubMed
36.
• Capogrosso P, Ventimiglia E, Ferrari M, et al. Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most? Int J Impot Res. 2016;28:189–93. Retrospective review of sexual function outcomes after HoLEP. Most did not experience significant change in IIEF scores at 12 years; however, 17% improved while 37% did decrease. Men with the higher IPSS and lower IIEF scores were more likley to improve. CrossRefPubMed
37.
Kim JK, Cho MC, Son H, Ku JH, Oh SJ, Paick JS. Patient perception of ejaculatory volume reduction after holmium laser enucleation of the prostate (HoLEP). Urology. 2017;99:142–7.CrossRefPubMed
38.
•• Rivera ME, Frank I, Viers BR, Rangel LJ, Krambeck AE. Holmium laser enucleation of the prostate and perioperative diagnosis of prostate cancer: an outcomes analysis. J Endourol. 2014;28:699–703. Large, single-institution review of incidence and predictors of ICaP. CaP identified in 5.6% of patients. Multivariate analysis identified increased age and PSAD as predictors. Overall survival was 72.8% at 5 years and 63.5% at 10 years for patient’s with ICaP. CrossRefPubMed
39.
Elkoushy MA, Elshal AM, Elhilali MM. Incidental prostate cancer diagnosis during holmium laser enucleation: assessment of predictors, survival, and disease progression. Urology. 2015;86:552–7.CrossRefPubMed
40.
Suardi N, Scattoni V, Briganti A, et al. Nerve-sparing radical retropubic prostatectomy in patients previously submitted to holmium laser enucleation of the prostate for bladder outlet obstruction due to benign prostatic enlargement. Eur Urol. 2008;53:1180–5.CrossRefPubMed
41.
Gellhaus PT, Monn MF, Leese J, et al. Robot-assisted radical prostatectomy in patients with a history of holmium laser enucleation of the prostate: feasibility and evaluation of initial outcomes. J Endourol. 2015;29:764–9.CrossRefPubMed
42.
Wasson JH, Bubolz TA, Lu-Yao GL, Walker-Corkery E, Hammond CS, Barry MJ. Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997. For the Patient Outcomes Research Team for Prostatic Diseases. J Urol. 2000;164:1212–5.CrossRefPubMed
43.
Madersbacher S, Lackner J, Brossner C, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005;47:499–504.CrossRefPubMed
44.
Guo S, Muller G, Lehmann K, et al. The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study. Lasers Med Sci. 2015;30:1147–51.CrossRefPubMed
45.
Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N. Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital. J Endourol. 2012;26:878–83.CrossRefPubMed
46.
•• Marien T, Kadihasanoglu M, Tangpaitoon T, et al. Outcomes of holmium laser enucleation of the prostate in the re-treatment setting. J Urol. 2017;197:1517–22. Large multicenter series comparing primary HoLEP to HoLEP after a previous outlet surgery. Postoperatively, both groups improved significanlty from baseline with no differences seen between the groups in Q m and PVR. Primary HoLEP patients had lower AUA symptom scores postoperatively than rHoLEP patients.
47.
Elshal AM, Elmansy HM, Elhilali MM. Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH). BJU Int. 2012;110:E845–50.CrossRefPubMed
48.
Jaeger CD, Krambeck AE. Holmium laser enucleation of the prostate for persistent lower urinary tract symptoms after prior benign prostatic hyperplasia surgery. Urology. 2013;81:1025–9.CrossRefPubMed
49.
• McAdams S, Funk JT, Navetta AF, El Tayeb MM, Humphreys MR. Holmium laser enucleation of the prostate after prostatic urethral lift surgery: feasibility and technical considerations from a multi-institutional case series. J Endourol. 2017;31:774–9. Small series describing HoLEP and PUL demonstrating feasibility.
Metadaten
Titel
Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes
verfasst von
Joseph M. Kuebker
Nicole L. Miller
Publikationsdatum
01.12.2017
Verlag
Springer US
Erschienen in
Current Urology Reports / Ausgabe 12/2017
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-017-0746-z

Weitere Artikel der Ausgabe 12/2017

Current Urology Reports 12/2017 Zur Ausgabe

Urosurgery (P Sooriakumaran, Section Editor)

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)

New Devices and Technologies for the Management of Overactive Bladder

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Early Results

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Predictability and Practicality of Image-Based Scoring Systems for Patient Assessment and Outcome Stratification During Percutaneous Nephrolithotomy: a Contemporary Update

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Spatial Tracking of Targeted Prostate Biopsy Locations: Moving Towards Effective Focal Partial Prostate Gland Ablation with Improved Treatment Planning

Neu im Fachgebiet Urologie

Hypertherme Chemotherapie bietet Chance auf Blasenerhalt

07.05.2024 Harnblasenkarzinom Nachrichten

Eine hypertherme intravesikale Chemotherapie mit Mitomycin kann für Patienten mit hochriskantem nicht muskelinvasivem Blasenkrebs eine Alternative zur radikalen Zystektomie darstellen. Kölner Urologen berichten über ihre Erfahrungen.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Männern mit Zystitis Schmalband-Antibiotika verordnen

03.05.2024 Zystitis Nachrichten

Die akute Zystitis von Männern und ihre Therapie sind wenig erforscht. Norwegische Forscher haben das nachgeholt. Ihr Rat: Erst einmal keine Breitbandantibiotika verordnen.

Bestrahlung nach Prostatektomie: mehr Schaden als Nutzen?

02.05.2024 Prostatakarzinom Nachrichten

Eine adjuvante Radiotherapie nach radikaler Prostata-Op. bringt den Betroffenen wahrscheinlich keinen Vorteil. Im Gegenteil: Durch die Bestrahlung steigt offenbar das Risiko für Harn- und Stuhlinkontinenz.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise