Holmium Laser Enucleation of the Prostate (HoLEP) for Small, Large and Giant Prostatic Hyperplasia: Tips and Tricks

Глыбочко, П. В.; Rapoport, L.; Enikeev, Mikhail; Enikeev, Dmitry

doi:10.5301/uj.5000232

Cited by 24 publications

(33 citation statements)

References 17 publications

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“…One of the most discussed disadvantages of laser enucleation in prostates <80 cc is the longer duration of surgery. However, this difference – although being statistically significant – did not exceed 10–15 min in most comparison studies . In the present study, the mean difference between the duration of the techniques was 7 min.…”

Section: Discussioncontrasting

confidence: 69%

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

et al. 2019

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Objective: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc). Methods: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification. Results: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 AE 10.2 vs 39.9 AE 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 AE 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 AE 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 AE 0.4 g/dL and 1.1 AE 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 AE 0.8 g/dL and 4.1 AE 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316). Conclusions: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma.Key words: benign prostatic hyperplasia, endoscopic enucleation of the prostate, enucleation of the prostate, thulium fiber laser, transurethral resection of the prostate.

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Section: Discussioncontrasting

confidence: 69%

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

et al. 2019

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“…In previous studies on such complications, no differences were reported in terms of urgency, dysuria, and transient incontinence between the TURP and HoLEP groups [7]. In another study, 5 cases of blood transfusion requirement and 38 cases of transient incontinence were noted among 459 patients who underwent HoLEP [19]. Kuntz et al [17] reported a transfusion requirement rate of 0% in their HoLEP group and 13.3% in their OPS group (p = 0.003).…”

Section: Discussionmentioning

confidence: 96%

“…However, catheter removal time (1.5-1.07 vs. 4.1-0.5 days, p < 0.001) and hospitalization time (2.7-1.1 vs. 5.4-1.05 days, p < 0.001) were shorter in the HoLEP group than in the OSP group [18]. Further, Glybochko et al [19] compared the efficacy of HoLEP for different PVs. They divided patients into 3 groups according to the PVs; group 1 (< 100 mL), group 2 (100-200 mL), and group 3 (> 200 mL).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and > 80 mL

Gazel

Kaya²,

Yalçın³

et al. 2019

Urol Int

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Introduction: Holmium laser enucleation of the prostate (HoLEP) is becoming the new standard procedure for treating benign prostatic hyperplasia (BPH), a common condition in aging men. Most studies have focused on proving its efficacy in treating large prostates. In this study, we compared its efficacy in treating small (< 80 mL) and large (> 80 mL) prostates. Methods: This prospective study included 119 patients with BPH who underwent HoLEP by the same surgeon between June 2015 and December 2017. They were divided into 2 groups according to their prostate volumes (≤80 mL: Group 1; > 80 mL: Group 2). Various pre- and postoperative parameters were compared within and between the groups. Results: International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, and voiding time (VT) significantly decreased, and the peak urinary flow rate (Qmax), average urinary flow rate (Qave), and quality of life (QoL) score significantly increased postoperatively in both groups. The postoperative changes in IPSS, QoL score, Qmax, Qave, VT, PVR volume, and hemoglobin levels were not significantly different between the groups. In addition, no significant difference was observed in postoperative complications between the groups. Conclusions: Our results indicate that HoLEP is an effective procedure for treating both small and large prostates.

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“…GPH, which is defined as prostate volume larger than 200 mL, has been described in several individual patients as case reports in a review of international scientific literature (14)(15)(16)(17)(18)(19). Individual cases of patients with severe LUTS from GPH whom underwent treatment with surgery or minimally invasive ablative urological treatment have also been reported (20)(21)(22)(23)(24)(25)(26). However the safety and long-term efficacy of PAE for treatment of large cohorts of patients with severe LUTS from GPH has not been examined.…”

Section: Introductionmentioning

confidence: 99%

Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

Somwaru¹,

Metting

Flisnik

et al. 2020

Preprint

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Background Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume larger than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective study examined the safety and long-term efficacy of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large cohort of patients. Methods 72 patients with GPH and severe LUTS who underwent PAE were retrospectively evaluated. PAE was performed bilaterally with two embolic agents in sequence: 100 µm to 250 µm embolic particles followed by 2 mm and 3 mm coils. Clinical assessment was performed by collecting international prostate symptoms score (IPSS), quality of life (QoL), and post-void residual volume (PVR) before PAE and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before PAE and 12 months and 24 months after PAE. Results Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, PVR, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < .0.01) at 12 months and to 10.5 (P < .0.01) at 24 months. Mean QoL decreased from 6.0 to 4.0 (P < 0.01) at 12 months and to 2.0 (P < 0.01) at 24 months. Mean PVR decreased from 198.0 mL to 152.0 mL (P < 0.01) at 12 months and to 90 mL (P < 0.01) at 24 months. Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) at 12 months and to 209.0 mL (P < 0.01) at 24 months. There were no major complications. Conclusions PAE is a safe treatment option with long term efficacy in patients with severe LUTS due to GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.

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Holmium Laser Enucleation of the Prostate (HoLEP) for Small, Large and Giant Prostatic Hyperplasia: Tips and Tricks

Abstract: HoLEP is a safe, highly efficacious and a size-independent procedure.

Cited by 24 publications

References 17 publications

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and > 80 mL

Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

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Holmium Laser Enucleation of the Prostate (HoLEP) for Small, Large and Giant Prostatic Hyperplasia: Tips and Tricks

Abstract: HoLEP is a safe, highly efficacious and a size-independent procedure.

Cited by 24 publications

References 17 publications

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and &#x3e; 80 mL

Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

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Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and > 80 mL