Abstract
Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.
Highlights
Affecting nearly 75% of men in the seventh decade, benign prostatic hyperplasia (BPH) is one of the most commonPawel Trotsenko and Christian Wetterauer contributed to this work.Dependent on the prostate volume (PV), different surgical techniques are used [2]
We reviewed the medical charts of 350 consecutive patients who had presented with symptomatic BPH and had undergone holmium laser enucleation of the prostate (HoLEP) surgery at our institution between June 2012 and May 2019
Between June 2012 and May 2019, HoLEP was successfully performed in a total of 350 patients
Summary
Affecting nearly 75% of men in the seventh decade, benign prostatic hyperplasia (BPH) is one of the most commonPawel Trotsenko and Christian Wetterauer contributed to this work.Dependent on the prostate volume (PV), different surgical techniques are used [2]. Affecting nearly 75% of men in the seventh decade, benign prostatic hyperplasia (BPH) is one of the most common. Pawel Trotsenko and Christian Wetterauer contributed to this work. Dependent on the prostate volume (PV), different surgical techniques are used [2]. For volumes of less than 80–100 cm, transurethral resection of the prostate (TUR-P) is still considered the gold standard [2,3,4]. In patients with larger PV, open prostatectomy (OP) is the most common approach used in many parts of Europe [5]. In the course of the introduction of modern laser technologies, holmium laser enucleation of the prostate (HoLEP) has emerged as a minimally invasive alternative treatment option for PV exceeding 80 cm. Several randomized controlled trials could demonstrate that HoLEP and OP are
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