Holmium Laser Enucleation of the Prostate: Initial Report of the First 230 Egyptian Cases Performed in a Single Center

Abdel-Hakim, Amr M.; Habib, E; El-Feel, Ahmed; Elbaz, Ahmed G; Fayad, Amr; Abdelhakim, Mai; Meshref, Alaa

doi:10.1016/j.urology.2009.12.035

Cited by 20 publications

(11 citation statements)

References 28 publications

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“…Previous studies in HoLEP demonstrated an increase in maximal flow rate and a decrease in postvoid residual volume after HoLEP [5, 26, 27], and QoL improved significantly [28]. These were consistent with our results.…”

Section: Discussionsupporting

confidence: 92%

Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study

Lee

Kim

et al. 2017

PLoS ONE

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ObjectiveTo investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study.Subjects and methodsFrom May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of ‘satisfaction with treatment question’ (STQ), ‘overall response assessment’ (ORA), and ‘willingness to undergo surgery question’ (WSQ).ResultsA total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with ‘dissatisfied’, and no patients replied with ‘very dissatisfied’. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively.ConclusionsThe overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.

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Section: Discussionsupporting

confidence: 92%

Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study

Lee

Kim

et al. 2017

PLoS ONE

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“…Substantial advantages were determined concerning the catheterization period and hospital stay in BPEP cases (1.5 and 2.1 day) but also according to HoLEP trials (1.35–1.79 days and 1.3–2.9 days , respectively) when facing a comparison with the OP arm in the present study (5.7 and 6.9 days) and related literature results (5–7 days and 6–9.2 days ). Consequently, the shorter postoperative recovery, otherwise one of the main goals of the newly introduced BPH therapeutic approaches, seemed to be within the reach of the plasma enucleation procedure.…”

Section: Discussionsupporting

confidence: 50%

“…While looking at the medium‐term functional outcome of the plasma enucleation and transvesical procedures, similar Q max values were provided at the 1‐, 3‐, 6‐ and 12‐month check‐ups subsequent to these techniques (24.1 vs 24.3 mL/s, 25.0 vs 24.9 mL/s, 25.6 vs 25.2 mL/s and 25.4 vs 25.1 mL/s). When referring to the respective urodynamic parameters specific for HoLEP, quite similar determinations were emphasized according to the published data at the respective follow‐up examinations (17.8–26.6 mL/s , 15.78–27.2 mL/s , 17.8–29.9 mL/s and 20.9–26.16 mL/s ). More so, the above‐mentioned figures of our analysis favourably matched the OP related literature on the maximum flow rate registered during the first year after surgery (23.7–26.6 mL/s , 14.5–25.5 mL/s , 15.6–27.0 mL/s and 16.4–28.8 mL/s ).…”

Section: Discussionmentioning

confidence: 69%

“…From the point of view of short‐term adverse events, in this study recatheterization for acute urinary retention was significantly more frequent in transvesical prostatectomy patients (7.1% vs 1.4%), as also confirmed in other trials with regard to standard OP (7.6%–16.67% ). This parameter appeared to be marked by a rather wide range of results when discussing the HoLEP‐specific outcome and varied between 1.2%–3% and 7.8%–12.1% . Additionally, the rates of irritative symptoms (11.4% vs 7.1%) and urinary tract infections (2.9% vs 5.7%) were statistically similar for BPEP and OP.…”

Section: Discussionmentioning

confidence: 94%

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Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases – a medium term, prospective, randomized comparison

et al. 2013

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What's known on the subject? and What does the study add?• According to the EAU Guidelines 2012, large size benign prostatic hyperplasia (BPH) cases (>80 mL) continue to have open prostatectomy as the first line treatment alternative, despite the substantial peri-operative morbidity and extended catheterization and convalescence periods related to this undoubtedly invasive approach. During the past two decades, holmium laser enucleation of the prostate was constantly described as a successful choice for this category of patients. According to rather numerous studies, the technique displayed superior results in terms of surgical safety and postoperative recovery compared with the open procedure. On the other hand, the concept of electrosurgical enucleation of the prostate, using either a monopolar or bipolar cutting current, materialized into several technical applications that eventually failed to gain general acknowledgement as reliable alternatives to the BPH transurethral approach.• While keeping in mind the already proved advantage of enucleating substantial quantities of BPH tissue, bipolar plasma enucleation of the prostate was introduced as a novel endoscopic approach in cases of large prostates. The present trial represents the first prospective, medium-term, randomized comparison to be published of this innovative technique with standard open prostatectomy. Basically, the premises for a viable alternative relied on the practical advantages provided by the 'button' electrode, mainly the large surface creating the conditions for a fast enucleation process, continuous vaporization and concomitant haemostasis. Eventually, it was concluded that the plasma enucleation procedure distinguished itself as a successful treatment option in large BPH patients, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Most importantly, plasma-button enucleation patients benefited from a similar 12 months' outcome from the perspectives of symptom scores and voiding parameters when drawing a parallel with open surgery results, thus underlining the reliable viability of this type of endoscopic approach. Objectives• To evaluate the viability of bipolar plasma enucleation of the prostate (BPEP) by comparison with open transvesical prostatectomy (OP) in cases of large prostates with regard to surgical efficacy and peri-operative morbidity.• To compare the medium-term follow-up parameters specific for the two methods. Patients and Methods• A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume >80 mL, maximum flow rate (Qmax) <10 mL/s and International Prostate Symptom Score (IPSS) >19 were randomized in the two study arms.• All cases were assessed preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, quality of life score (QoL) and post-voiding residual urinary volume (PVR).• The prostate volume and prostate speci...

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“…Unfortunately, most of them did not provide a better alternative for large-volume BPH [1] . Despite the high efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in treating BPH of all sizes, this procedure failed to gain widespread acceptance as it has a long learning curve and significant financial cost [3,4] . More recently, a laparoscopic transvesical approach was proposed by Sotelo et al [5] .…”

Section: Introductionmentioning

confidence: 99%

‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

El-Karamany

Al-Adl

Abdel-baky

et al. 2014

Arab Journal of Urology

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ObjectiveTo describe the surgical technique and report the early outcomes of a ‘minimum-incision’ endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate.Patients and methodsIn a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Qmax), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien–Dindo score.ResultsThe mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80–160) g, the operative duration was 52 (8, 40–65) min, the haemoglobin loss was 2.1 (1, 0.4–5) g/dL, the catheterisation time was 5.2 (1.3, 4–9) days, and the hospital stay was 6.2 (1.4, 5–10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001).ConclusionMEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH.

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Holmium Laser Enucleation of the Prostate: Initial Report of the First 230 Egyptian Cases Performed in a Single Center

Cited by 20 publications

References 28 publications

Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study

Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study

Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases – a medium term, prospective, randomized comparison

‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

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