Abstract
Objectives: Holmium laser enucleation of the prostate (HoLEP) can be used regardless of prostate size and offers durable long-term results for patients suffering from lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO), with reduced perioperative morbidity. In most western societies almost half of the population are overweight, and obesity itself is often a risk factor for surgical treatment of patients. We therefore analysed the impact of body mass index (BMI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral centre. Methods: We retrospectively collected data for 877 patients who underwent HoLEP for LUTS/BPO between 2014 and 2018 and divided patients into group 1 (BMI<25), 2 (BMI 25<30), and 3 (BMI⩾30). We analysed perioperative parameters, safety, and short-term functional outcomes. Results: In preoperative patient characteristics we observed a similar LUTS profile throughout our patient cohorts. The highest proportion of ASA score ⩾III was observed in the obese patient cohort. Enucleation time was significantly prolonged in morbidly obese patients and operative speed was significantly slower, without difference in perioperative complications. Functional outcomes were assessed 30 days post-surgery with significant improvement in IPSS, quality of life (QoL) and Qmax for all groups. Conclusion: Although operating on overweight and obese patients takes significantly longer, HoLEP is efficient and offers acceptable perioperative complication rates even in morbidly obese patients (BMI⩾30). Level of evidence: Not applicable.
Highlights
Transurethral resection of the prostate (TURP) and open transvesical prostatectomy (OP) are established surgical methods for treatment of prostate enlargement
We observed a statistical difference in preoperative haemoglobin levels between groups, with a median of 14.5 g/dl (IQR 13.715.3), 14.9 g/dl (IQR 14.0-15.7) and 15.0 g/dl (IQR 14.115.8) for groups 1, 2 and 3, respectively
As a demographic shift in western societies will lead to an ever-ageing population, benign prostatic diseases such as lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) will become more prevalent in patients presenting with obesity posing as an important risk factor when undergoing surgery for LUTS/BPO.[1,11]
Summary
Transurethral resection of the prostate (TURP) and open transvesical prostatectomy (OP) are established surgical methods for treatment of prostate enlargement. It has even been considered the “new gold standard” for surgical intervention in LUTS secondary to BPO.[8]
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