Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc)

Zell, M.; Abdul-Muhsin, Haidar; Navaratnam, Anojan; Cumsky, Jameson; Girardo, Marlene; Cornella, Joseph; Nevo, Amihay; Cheney, Scott; Humphreys, Mitchell R.

doi:10.1007/s00345-020-03156-5

Cited by 38 publications

(43 citation statements)

References 21 publications

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“…36 In a study on the use of HoLEP in prostates over 200 mL, IPSS was reduced by 63% and QoL by 43% (►Table 7). 37 At our institution, PAE has produced results similar to performing TURP, Rezum, UroLift, and PVP on prostates <80 mL and to enucleation and simple prostatectomy on prostates >80 mL. These data support the use of PAE in large prostates >80 mL and in patients who are poor surgical candidates, or who desire a less invasive procedure than simple prostatectomy.…”

Section: Discussionsupporting

confidence: 55%

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Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Pike

Abel

Seckel

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.

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Section: Discussionsupporting

confidence: 55%

“…Prostates were >200 mL; other studies [33][34][35][36][37] did not assess change in prostate volume.…”

Section: Discussionmentioning

confidence: 99%

Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Pike

Abel

Seckel

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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“…With the advent of laser technology, bleeding has become an uncommon complication of surgery for BPH. The overall transfusion rates in contemporary HoLEP series range from 0% to 4% [14,15]. In our experience of >2000 HoLEPs, bleeding is virtually always manageable with decreasing the energy density by either defocussing the laser or decreasing the energy pulse.…”

Section: Discussionmentioning

confidence: 86%

Holmium laser enucleation of the prostate using Moses 2.0 vs non‐Moses: a randomised controlled trial

et al. 2020

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To compare the enucleation efficiency of Moses 2.0 with non-Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP). Patients and MethodsA double-blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse TM 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non-Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies. ResultsA total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P < 0.01) compared to non-Moses. When HoLEP procedures were performed by an expert, Moses 2.0 resulted in shorter enucleation time (21 vs 36.7 min, P = 0.016) and higher enucleation efficiency (1.75 vs 1.05 g/min, P = 0.05) compared to non-Moses. When HoLEP was performed by trainees, the Moses 2.0 cohort had a shorter haemostasis laser time (4.1 vs 9 min, P = 0.035) compared to the non-Moses. Fibre degradation was lower with Moses 2.0 compared to non-Moses for both experts and trainees. Moses 2.0 received a higher score than the standard technology for the incision sharpness, fibre control, tissue separation, tissue damage, haemostasis, visibility, and charring. The overall inter-observer correlation coefficient was 0.63. ConclusionMoses 2.0 has higher enucleation efficiency compared to non-Moses when used by experts. The subjective evaluation favoured Moses 2.0.

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“…HoLEP has no upper PV limit in experienced hands. Its safety and outcomes have been reported in men with extremely large prostates [1]. In comparison to open prostatectomy it is as effective, but less morbid [2].…”

Section: Management Considerationsmentioning

confidence: 99%

‘Case of the Month’ from Cambridge University, UK: managing intractable bleeding from a 375 cc prostate in an anti‐coagulated patient

et al. 2020

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Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc)

Cited by 38 publications

References 21 publications

Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Holmium laser enucleation of the prostate using Moses 2.0 vs non‐Moses: a randomised controlled trial

‘Case of the Month’ from Cambridge University, UK: managing intractable bleeding from a 375 cc prostate in an anti‐coagulated patient

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