Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia

doi:10.1016/S0090-4295(99)80381-1

Urology

Volume 47, Issue 1, January 1996, Pages 48-51

https://doi.org/10.1016/S0090-4295(99)80381-1 Get rights and content

Abstract

Objectives

To assess the early efficacy and safety of holmium laser resection of the prostate (HoLRP) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH).

Methods

The initial 84 patients undergoing HoLRP at this institution are reported. All patients underwent standard urologic evaluation for BPH with American Urological Association (AUA) symptom score, peak urinary flow rate (Q_max), ultrasound prostate volume estimation, prostate-specific antigen and digital rectal examination. The patients were reassessed at 1 month (72 patients) and 3 months (48 patients) postoperatively. The resection time, total operating time, holmium energy used (kilojoules), catheter time, and hospital stay were all recorded.

Results

The mean patient age was 65.3 years (49 to 80). The mean AUA score improved from 21.3 preoperatively to 7.6 at 1 month and 4.1 at 3 months. The mean Q_max likewise increased from 7.5 mL/s preoperatively to 17.8 mL/s at 1 month and 19.3 mL/s at 3 months. Two patients (2%) required bladder irrigation for heavy hematuria perioperatively and 4 patients (5%) required recatheterization. Few patients experienced irritative urinary symptoms and to only a mild degree.

Conclusions

The technique of HoLRP produces a cavity identical in appearance to transurethral resection of the prostate. It is a relatively bloodless procedure that results in a short catheter time, immediate symptomatic improvement, and minimal postoperative irritative symptoms. The short-term results are excellent but longer-term follow-up is necessary.

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Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum
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To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates.
A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40 g (group 1), 41-200 g (group 2), and >200 g (group 3). Various preoperative, perioperative, and postoperative variables were collected.
HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P = .022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P = .019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P = .048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups.
HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.
Efficacy, Efficiency, and Safety of En-bloc vs Three-lobe Enucleation of the Prostate: A Propensity Score-matched Analysis
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To assess efficacy, efficiency, and safety in holmium laser enucleation of the prostate (HoLEP), we directly compared intraoperative performance, postoperative outcomes, and safety in the original 3-lobe enucleation technique with the more recent en-bloc method. As HoLEP is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), detailed understanding of its benefits is mandatory.
We conducted a retrospective, propensity score-matched analysis of 1,396 men who underwent HoLEP for LUTS/BPO between 2017 and 2020. We included 606 patients in the final analysis (en-bloc n = 303; 3-lobe n = 303), who were matched for prostate size (50 cc), age, body mass index, and preoperative international prostate symptom score. Patients were then stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes.
While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly less adverse events (Clavien-Dindo classification ≥II vs <II) for patients receiving en-bloc enucleation. Additionally, en-bloc enucleation was more efficient, that is, less than half of total laser energy (kJ), twice shorter enucleation time, and surgical performance (g/kJ/min) significantly increased 4-fold with prostate volume, compared to 3-lobe enucleation.
While HoLEP in general is a safe and effective procedure, en-bloc enucleation techniques offer better surgical performance.
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Adult urologyHolmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia

Abstract

Objectives

Methods

Results

Conclusions

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Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia