Holmium laser enucleation of the prostate: a paradigm shift in benign prostatic hyperplasia surgery

Park

et al. 2015

Korean J Urol

PurposeOur objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses.Materials and MethodsFrom January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed.ResultsMultiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient.ConclusionsTransurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

Section: Discussionmentioning

confidence: 99%

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

Park

et al. 2015

Korean J Urol

“…Accordingly, there has been a paradigm shift to HoLEP as the primary surgery in modern BPH, which alleviates LUTS and improves urodynamic study (UDS). 6,7) HoLEP with mechanical morcellation can be divided into two processes: gross tissue resection or enucleation and morcellation to extract enucleated prostatic tissue from the body. The early practice of leaving prostate tissue in the bladder after HoLRP caused problems.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of X-incision with Inversed Morcellation in Holmium Laser Enucleation of the Prostate: Comparison to Conventional Morcellation

Park

Hwang

et al. 2019

Ann Geriatr Med Res

Background: Three-quarters of aged men experience lower urinary tract symptoms with benign prostate hypertrophy (BPH). Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) are standard endosurgical procedures in patients with BPH. Previous studies reported better results in patients undergoing HoLEP than in those undergoing TURP. Methods: This study compared the efficiency and safety of conventional morcellation and morcellation performed after X-incision during enucleation, a newly added technique in HoLEP. Overall, 174 patients were selected as the final study population. The populations were stratified with respect to resected volumes. A t-test were used to compare the conventional morcellation and X-incision procedure groups. Results: In morcellation times and rates, there were significant differences in stratified resected mass (g) between the groups. The results also showed a decreased incidence of bladder injury as a surgical complication. Conclusion: We believe morcellation performed after X-incision procedure during enucleation is efficient and safe for older adults with BPH.

“…Since that time, TURP has been considered the standard surgical treatment of small to moderate-size obstructive BPH. The American Urological Association guidelines define TURP as the ‘‘gold standard’’ surgical treatment for BPH [1-3]. Holmium laser enucleation (HoLEP) was developed in the 1990s as a surgical treatment for BPH that is more effective and safer than laser vaporization and traditional resection techniques.…”

Section: Introductionmentioning

confidence: 99%

“…HoLEP has become the novel standard for the surgical treatment of BPH because it is effective while being less invasive and having a low incidence of complications. The effectiveness and safety of HoLEP to treat BPH are well known; recently, this technique has been used on prostates of various sizes [3]. Many studies have compared the effectiveness of HoLEP and TURP in terms of improvement in voiding symptoms, maximal flow rate (Qmax), postvoid residual volume (PVR), the International Prostate Symptom Score (IPSS), and complications.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity

Woo

et al. 2017

Int Neurourol J

PurposeCurrently, holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the standard surgical procedures used to treat benign prostatic hyperplasia (BPH). Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU) can effectively improve voiding symptoms, but comparative data on the efficacy of HoLEP and TURP are insufficient. Therefore, we compared the short-term surgical outcomes of HoLEP and TURP in patients with DU.MethodsFrom January 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32). Surgical outcomes were retrospectively compared between the 2 groups. DU was defined as a detrusor pressure at maximal flow rate of <40 cm H2O as measured by a pressure flow study.ResultsThe preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups. The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033). The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group.ConclusionsHoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.