Holmium laser enucleation of the prostate: a review of the clinical trial evidence

Cynk, Mark

doi:10.1177/1756287213511509

Cited by 20 publications

(16 citation statements)

References 55 publications

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“…Laser endoscopic enucleation (mainly holmium laser enucleation of the prostate [HoLEP] [3], eraser laser enucleation of the prostate [ELEP] [4] and thulium vapo-enucleation of the prostate [ThuVEP] [5]) of the prostate is becoming the new trend for BPH treatment for prostates of >80 mL, with comparable results and a better safety profile than the classical open simple prostatectomy (SP) [6][7][8][9]. Nonetheless, a considerable number of urologists are relying on SP as the treatment of choice for high-volume BPH, especially with the development of minimally invasive laparoscopic and robot-assisted SP (LSP and RASP) that benefit from the same perioperative results of the open technique, but with a better safety profile [10,11].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive simple prostatectomy in the era of laser enucleation for high-volume prostates: A systematic review and meta-analysis

Chebel

Sarkis

Helou

et al. 2020

Arab Journal of Urology

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Objective: To perform a systematic review and meta-analysis of available prospective and retrospective studies comparing the minimally invasive (laparoscopic or robot-assisted) simple prostatectomy (MISP) and laser enucleation of the prostate for treating male lower urinary tract symptoms in high-volume prostates, as laser enucleation of the prostate is the new trend for treating high-volume prostates (>80 mL) but many urologists now prefer MISP. Methods: A systematic search was done using the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane databases in June 2019, with research terms including: 'laser', 'laparoscopy', 'enucleation', 'BPH', 'simple prostatectomy', 'Millins', and 'adenomectomy'. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of 38 screened articles, six were analysed and a total of 975 men were included. The average operative time, length of stay and catheterisation time were significantly shorter in the laser enucleation group (P = 0.006, P < 0.001 and P < 0.001, respectively). The amount of prostatic tissue removed during surgery was comparable between both the laser enucleation and MISP groups (P = 0.39). The International Prostate Symptom Score, prostate-specific antigen level, maximum urinary flow rate and post-void residual urine volume were also comparable at 3 months. Finally, similar transfusion rates and Clavien-Dindo complication rates were observed (P = 0.08 and P = 0.41, respectively). Conclusion: This systematic review of the literature and meta-analysis provide a further demonstration of the safety and effectiveness of both laser enucleation and MISP. While laser enucleation had a shorter catheterisation time and hospital stay than MISP, the latter still had unique and specific indications. Abbreviations: ELEP: eraser laser enucleation of the prostate; HoLEP: holmium laser enucleation of the prostate; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PVR: post-void residual urine volume; Q max : maximum urinary flow rate; (L)(MI)(RA)SP: (laparoscopic) (minimally-invasive) (robot-assisted) simple prostatectomy ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Minimally invasive simple prostatectomy in the era of laser enucleation for high-volume prostates: A systematic review and meta-analysis

Chebel

Sarkis

Helou

et al. 2020

Arab Journal of Urology

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“…As technology has evolved in the past few years, the rate of alternative minimal invasive surgical therapies (MISTs) including GreeLight photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP) have increased [2] . Several studies have determined comparable e cacy for MISTs and TURP [3,4,5] .…”

Section: Introductionsmentioning

confidence: 99%

Noise Exposure During Minimally Invasive Benign Prostatic Hyperplasia Laser Surgery Procedures

Xia

Tong

Shi

et al. 2022

Preprint

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Objective: To monitor the occupational noise exposure during minimally invasive benign prostatic hyperplasia (BPH) laser surgery procedures in the operating room.Methods: A wireless noise level meter was used to monitor the noise exposure to the surgeon and patients during different BPH laser surgery procedures. The sound level were recorded during 180-W Photoselective vaporization of the prostate surgery (Realton Co., Beijing,China ), 100-W Holmium laser enucleation of the prostate(HoLEP, VersaPulse Power-Suite, Lumenis Ltd),90-W HoLEP (Dahua Laser Co., Jiangsu, China) and 60-W HoLEP (VersaPulse Power-Suite, Lumenis Ltd). Maximum peak level and time-average decibel level were measured. State Anxiety Inventory (S-AI) scores of 37 surgeons from 5 hospitals after an 8-h working day for different laser surgery were recoreded.Results: The mean background sound levels in the operation room prior to laser surgery was 48dB within a range of 40~54 dB. A maximum sound level of 91 dB was recorded at level of surgeon’ head during the working of 100-W HoLEP machine, while the mean decibel level was 85dB. Use of the 90-W HoLEP machines achieved the lowest mean decibel level (66 dB) recording both at level of surgeon’s and patient’s head. The sounds during 180-W PVP ranged from 60~77 dB at level of surgeon’s head and 60~75dB at patients’s head. The State Anxiety score was significantly higher in the 100-W HoLEP group compared with other groups (P<0.05).Conclusions: Our data showed the noise exposure during minimally invasive benign prostatic hyperplasia procedures. A modified cooling system in 90-W HoLEP machine could effectively reduce the noised emitted by the laser generator. Surgeons may experience uncomfortable and anxiety after an 8h working day for HoLEP. Music and noised-induced headphones may help to reduce negative emotion.

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Section: Introductionmentioning

confidence: 99%

“…5 For one of these new techniques to surpass the use of TURP and become the new gold standard of treatment it must have good functional outcomes, be cost effective, have a low complication rate and demonstrate durability with a low reoperation rate. 6 Holmium laser enucleation of the prostate (HoLEP) emerged as an alternative to TURP in 1996 in Tauranga, New Zealand. 7,8 We now have over two decades of evidence demonstrating the efficacy and superior outcomes of HoLEP to TURP.…”

Section: Introductionmentioning

confidence: 99%

Holmium laser enucleation of the prostate: A single-centre case series of 1000 patients

Whiting

Penev

Guest

et al. 2021

Journal of Clinical Urology

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Objective: To describe the short and long-term complications of over 1000 cases of Holmium laser enucleation of the prostate (HoLEP) in a single centre. Methods: A prospective database of all HoLEP procedures performed between December 2003 and March 2017 was analysed. Results: A total of 1016 HoLEP procedures were performed. Median patient age was 72 years (range 41–95). There was a significant improvement in urinary flow, post-void residual volume, IPSS and QoL score ( p < 0.0001). Pre-operative acute urinary retention was present in 403 patients (39.7%). Post-operatively five patients (1.2%) continued with a long-term catheter. Early and late complications consisted of failed initial voiding trial (10.6%), stress incontinence (transient 6.5%; persistent 0.3%), frequency/dysuria (5.6%), urinary tract infection (5.3%), urethral stricture (4.8%), submeatal stenosis (1.9%), return to theatre (1.5%), bladder neck stenosis (1.3%), bleeding (1.2%), epididymitis (0.7%), confusion (0.3%), transurethral resection of the prostate conversion (0.2%), ureteric obstruction (0.2%), vomiting (0.2%), anuric renal failure (0.1%), chest infection (0.1%), chest pain (0.1%), myocardial infarction (0.1%), rectoprostatic fistula (0.1%), supraventricular tachycardia (0.1%) and urinary sepsis (0.1%). Five-year reoperation rate was 3.7%. Conclusion: HoLEP is a safe treatment for bladder outflow obstruction secondary to an enlarged prostate. It is associated with few early and late complications and has a low reoperation rate. Level of evidence: 4

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Holmium laser enucleation of the prostate: a review of the clinical trial evidence

Cited by 20 publications

References 55 publications

Minimally invasive simple prostatectomy in the era of laser enucleation for high-volume prostates: A systematic review and meta-analysis

Minimally invasive simple prostatectomy in the era of laser enucleation for high-volume prostates: A systematic review and meta-analysis

Noise Exposure During Minimally Invasive Benign Prostatic Hyperplasia Laser Surgery Procedures

Holmium laser enucleation of the prostate: A single-centre case series of 1000 patients

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