Peri‐operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature

Abstract

OBJECTIVE To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. PATIENTS AND METHODS We analysed the patients’ demographic, peri‐operative and follow‐up data, and the complications during and after surgery. RESULTS HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re‐catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%). CONCLUSIONS There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient.

Salvage Holmium laser enucleation of prostate to treat recurring benign prostatic hyperplasia

“…2,15 In the present study, apex tissue was enucleated using the HoLEP technique. 16 A significant amount of lateral lobe tissue was found near the prostatic capsule, particularly in patients with larger prostates.…”

Predictors of Enucleation and Morcellation Time During Holmium Laser Enucleation of the Prostate

“…Furthermore, studies have reported that there is little variation in operative efficiency between surgeons and that comparable times can be achieved 17,24 . We found that although there is a twenty minute increase in enucleation time associated with less experienced surgeons, there is minimal difference in morcellation time.…”

“…Dual irrigation is used to keep the bladder full and to improve visualization. Irrigation was placed approximately [24][25][26][27][28][29][30] inches above the level of the bladder. Unusually tough prostatic tissue (termed "beach balls") may occasionally be encountered during enucleation which can prolong morcellation time.…”

Outcomes of the Holmium Laser Enucleation of the Prostate for Patients With Prior Benign Prostatic Hyperplasia Surgery

“…In some cases, there may be urine extravasations or massive bleeding due to severe perforation from bladder injury requiring open surgery 17,18) . However, the possibility of bladder injury during morcellation is less than 10% and many research reports that the extent of bladder injury was not severe 19) . This study was comparable with previous studies in preventing and reducing the extent of bladder injury.…”