Mp42-08 Outcomes of Holep Performed in the Retreatment Setting

Marien, Tracy; Kadıhasanoğlu, Mustafa; Tangpaitoon, Teerayut; York, Nadya; Blackburne, Andrew T.; Abdul-Muhsin, Haidar; Borofsky, Michael S.; Krambeck, Amy E.; Humphreys, Mitchell R.; Lingeman, James E.; Miller, Nicole L.

doi:10.1016/j.juro.2016.02.196

Cited by 4 publications

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“…Most recently, Marien et al compared 360 men who underwent retreatment of BPH following prior BPH surgery to 1,882 men undergoing primary HoLEP 41. They found that men in the retreatment arm actually had shorter operation times (86 vs 91 minutes, P =0.003), lower blood loss (36 vs 80 mL, P =0.0001), shorter length of stay (1.1 vs 1.3 days, P =0.01), and not surprisingly less tissue resected (69 vs 76 g, P =0.023).…”

Section: Resultsmentioning

confidence: 99%

Holmium laser enucleation of the prostate: patient selection and perspectives

Marien

Kadıhasanoğlu

Miller

2016

RRU

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BackgroundMultiple endoscopic surgical options exist to treat benign prostatic hyperplasia (BPH), including holmium laser enucleation of the prostate (HoLEP). HoLEP alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by cutting tissue with the holmium laser, and removal of adenoma via morcellation. This article reviews patient selection for HoLEP in order to optimize outcomes, costs, and patient satisfaction.MethodsA literature review of all studies on HoLEP was conducted. Studies that focused on outcomes in regard to patient and procedural factors were closely reviewed and discussed.ResultsVarious studies found that men with large or small prostates, on antithrombotic therapy, in urinary retention, with bladder hypocontractility, with prostate cancer, undergoing retreatment for BPH, or in need of concomitant surgery for bladder stones and other pathologies do well with HoLEP, as demonstrated by excellent functional and symptomatic outcomes as well as low complication rates. There is a 74–78% rate of retrograde ejaculation following HoLEP. Techniques to preserve ejaculatory function following enucleative techniques have not been able to demonstrate a significant improvement.ConclusionPatient selection for HoLEP can include most men with bothersome BPH who have evidence of bladder outlet obstruction and are healthy enough to undergo surgery. The ability to safely perform concomitant surgery with HoLEP benefits the patient by sparing them an additional anesthetic and also decreases costs. Patients should be made aware of the risk of retrograde ejaculation following HoLEP and counseled on treatment alternatives if maintaining ejaculatory function is desired.

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Section: Resultsmentioning

confidence: 99%

Holmium laser enucleation of the prostate: patient selection and perspectives

Marien

Kadıhasanoğlu

Miller

2016

RRU

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“…found, in their comparison between initial treatment and retreatment with HoLEP, that the retreatment arm actually had shorter operation times, lower blood loss, shorter length of stay and, not surprisingly, less tissue resected. There was a slightly higher rate of postoperative clot retention in the retreatment HoLEP arm …”

Section: Surgical Retreatment Of Bphmentioning

confidence: 89%

“…There was a slightly higher rate of postoperative clot retention in the retreatment HoLEP arm. 19 Elshal et al found in their HoLEP retreatment study that the enucleation plane could be identified without extra difficulty in patients with prior BPH surgery. 20 HoLEP retreatment is considered technically feasible as well as safe, and offers excellent outcomes for men with previous BPH surgery.…”

Section: Surgical Retreatment Of Bphmentioning

confidence: 99%

Current status of holmium laser enucleation of the prostate

Shigemura

Fujisawa

2017

Int J of Urology

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There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan. The present review introduces the current status of holmium laser enucleation of the prostate, so that it surely contributes to the knowledge of International Journal of Urology readers who could be experienced surgeons or beginners as well.

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“…Moreover, the risk of clot retention and urethral stricture is low in a re-treatment setting but significantly higher than the primary HoLEP. 39…”

Section: Retreatment After Holepmentioning

confidence: 99%

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

et al. 2020

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Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

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Mp42-08 Outcomes of Holep Performed in the Retreatment Setting

Abstract: theoretical risk of fluid overload especially in patients with cardiac risk. Larger studies are needed to confirm these findings.

Cited by 4 publications

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Holmium laser enucleation of the prostate: patient selection and perspectives

Holmium laser enucleation of the prostate: patient selection and perspectives

Current status of holmium laser enucleation of the prostate

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

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