Holmium Laser enucleation of the prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP).

Luís Eduardo Durães Barboza,Luiz Edison Slongo,Paulo Afonso Nunes Nassif,Osvaldo Malafaia,Fernando Meyer,Eduardo Wendler,Fernando Issamu Tabushi,Rafael Alexandre Beraldi

doi:10.1590/0100-69912015003007

Abstract

to evaluate the effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP) - in the treatment of benign prostatic hyperplasia (BPH) - in comparison to transurethral resection of the prostate (TURP). patients with symptomatic prostatic hyperplasia and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At the hospital were collected: age, date of birth, international prostate symptom score, urinary peak flow rate, prostate volume, post-voiding residual urine, globular volume and serum PSA. At the procedure operating time, morcellating time (HoLEP), bladder mucosal injury and intercurrences were collected. At the first postoperative day, globular volume and sodium. Besides that were observed the catheter indwelling time and hospital stay and after 90 days, urinary peak flow rate and international prostate symptom score. Statistical analisys have been done partially by Sinpe(r) and also by a professional team. twenty patients in HoLEP group and 21 at TURP were operated. Baseline urinary peak flow rate was 8 ml/s in both groups and preoperative international prostate symptom score was 22 in HoLEP and 20 in TURP, very similar. Operative time was 85 minutes in HoLEP and 60 in TURP, p<0.05. Hospital stay was 47 hours for HoLEP and 48 hours to TURP, p<0.05. At 90 day the urinary peak flow rate was raised to 21.5 ml/s in HoLEP group and to 20 ml/s in TURP and the median of international prostate symptom score had been reduced to score 3 in both groups. HoLEP is a feasible technique and is as effective as TURP on symptomatic prostatic hyperplasia surgical treatment.

Highlights

Prostatic Benign Hyperplasia (BPH) is one of the most frequent diseases in men, and it has been considered part of the physiologic process of aging
Holmium laser enucleation of the prostate has become an attractive technique due to low morbidity and high efficacy; this is testified by symptom relief and by objective assessment of urinary peak flow rate and complete urodynamic findings[3]
In this study we have found a remarkable improvement on urinary symptoms in both groups, international prostate symptom score (IPSS) ranging from 22.5 to 3 points in Holmium Laser Enucleation of the Prostate (HoLEP) group and ranging from 20 to 3 in TURP group

Summary

Introduction

Prostatic Benign Hyperplasia (BPH) is one of the most frequent diseases in men, and it has been considered part of the physiologic process of aging. Complications and morbidity related to TURP including blood loss, fluid balance disturbances, excessive fluid absorption, incontinence and erectile dysfunction, have been estimated to develop in about 15% of patients[3] In this scenario the laser treatment for BPH has challenged TURP due to advances in laser technology, better understanding of tissue-laser interactions and growing clinical experience[4]. The holmium: YAG laser (Lumenis®, Tel Aviv, Israel) is a pulse solid state laser with many characteristics that make it ideal for endourological surgery It has a wavelength of 2.140nm that allows it to be strongly absorbed by tissue water, causing rapid vaporization of exposed tissues at a depth of approximately 0.4mm and producing coagulation 3 to 4 mm below the vaporization surface. This is useful and allows a precise, bloodless field, preventing systemic fluid absorption[3]

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Conclusion