Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Abstract

PurposeTo evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates.Materials and MethodsPatients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL≤TPV<200 mL), and group C (TPV≥200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery.ResultsA total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, ±7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7±36.9 mL and 4.15±4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture.ConclusionsHoLEP in patients with an extremely large prostate can be performed efficiently and safely.

Current surgical techniques of enucleation in holmium laser enucleation of the prostate

“…The detailed HoLEP surgical techniques used at Seoul National University Hospital were described in 2013 [6]. Although this technique is based on the three-lobe technique, it was modified to better preserve the sphincter around the prostate apex at the 12 o'clock position.…”

“…HoLEP shares the same surgical principles as open prostatectomy [4]. Therefore, HoLEP can be performed safely in patients with severe enlargement of the prostate [567]. The short- and long-term efficacy of HoLEP has already been proven in numerous studies [89101112].…”

Efficacy of Holmium Laser Enucleation of the Prostate in Patients with a Small Prostate (≤30 mL)

“…No major surgical complications were seen in our study series, including bladder injury during morcellation, and no patients had urinary incontinence after HoLEP. The main handicap of HoLEP is its steep learning curve, and HoLEP is known to be technically more difficult for both large and small prostates [ 28 29 ]. In small prostates, enucleation requires skill and capsular perforation may occur more frequently.…”

It's Time to Take Advantage of Robotic Assisted Simple Prostatectomy in Large Benign Prostatic Hyperplasia

“…Moreover, HoLEP has been shown to be associated with a higher enucleated tissue weight per enucleation time in large prostates, and theoretically to be a size-independent procedure [3]. However, HoLEP in extremely large prostate is challenging procedures, even after the surgeon has overcome the learning curve [45]. Technical challenges including bleeding risk, complex surgical plane, disturbance of surgical field, and difficulties in manipulating the resectoscope, are frequently encountered during the HoLEP of large prostates [45].…”

“…However, HoLEP in extremely large prostate is challenging procedures, even after the surgeon has overcome the learning curve [45]. Technical challenges including bleeding risk, complex surgical plane, disturbance of surgical field, and difficulties in manipulating the resectoscope, are frequently encountered during the HoLEP of large prostates [45]. Moreover, HoLEP does carry a risk of postoperative complications, including urethral stricture, incontinence.…”