Abstract
IntroductionHolmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve.Technical considerationsDetailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue.ConclusionsHoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior hemostasis, no risk of TUR syndrome, and a minimal hospital stay.
Highlights
Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH)
Symptoms generally worsen with age, with men experiencing a mean increase of the American Urological Association (AUA) symptom score of 0.18 points per year of follow-up[2] symptoms can often be handled adequately with medical therapy, patients who continue to suffer significant voiding problems will eventually require surgical intervention to avoid or treat long-term sequelae such as urinary retention, urinary tract infections, and bladder calculi
Historical development of HoLEP The holmium:YAG laser (2140 nm) acts through a predominantly photothermal mechanism.[5]. Because it is capable of vaporizing soft tissue, application of the holmium laser for BPH first focused on sequential ablation of tissue in order to enlarge a channel through the prostate
Summary
Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. With CELAP, a circumferential coagulation of prostatic tissue was first performed using the Nd:YAG laser, followed by vaporization of an adequately sized channel using holmium energy This combination procedure was still associated with significant indwelling catheterization times postoperatively, ranging from 4.1 to 7.1 days.[6,8] In addition, many patients required re-catheterization for urinary retention and had irritative voiding symptoms[4,9]. In order to achieve more efficiency, attention turned to developing a method of removing larger portions of adenoma
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