MP25-16 HOLMIUM ENUCLEATION OF THE PROSTATE WITH A GLAND VOLUME OVER 200CC

Abstract

INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended as a treatment option for bladder outlet obstruction for large volume benign prostatic hyperplasia in AUA, UK and European guidelines. It is unclear whether prostate volume (PV) limits HoLEP in terms of safety, efficacy or outcomes. The objectives of this study are to assess the feasibility, outcomes and techniques for HoLEP of prostates with a specimen weight over 150g (equivalent to a preoperative PV >200cc). METHODS: A retrospective review of a prospectively maintained database was conducted at a tertiary HoLEP center in the UK. All HoLEP procedures on glands with a specimen weight >150g were identified and reviewed. Outcomes measured included laser and morcellation times, use of cystotomy, change in serum hemoglobin (Hb), blood transfusion rates, and changes in IPSS, Qmax and PVR at 3 months. RESULTS: 127 patients were identified as having undergone HoLEP with a specimen weight 150g or above over a 14 year period. These were subdivided into three groups by specimen weight of 150-189g or 200-250cc (n= 70), 190-225g or 250-300cc (n=34) and >225g or >300cc (n=23). The median specimen weight was 185g (equivalent to pre-op PV = 250cc). Median enucleation and morcellation time was 70 minutes (range 40-150) and 45 minutes (range 12-240) respectively. Six patients underwent a concomitant cystotomy to remove lobes, four of whom had a specimen weight >225g. The mean length of stay was 1 day (range 0-14). The median change in Hb was 18g/L. The transfusion rate was 1.6%. The median preoperative IPSS in patients without an indwelling catheter was 19 versus 6 at 3 months postoperatively. 85% had a successful initial trial without catheter rising to 95% by second trial. The median preoperative Qmax in patients (without a catheter) was 8mL/s versus 22mL/s postoperatively. Outcomes stratified by specimen weight/equivalent preoperative PV are detailed in Table 1. CONCLUSIONS: HoLEP is feasible and safe for a PV >200cc. PV need not be a barrier to HoLEP in specialist centers. Most HoLEP outcomes are independent of PV, although the use of cystotomy is more common in men with prostates > 300cc. For a PV from 200-300cc and >300cc, we propose the terms mega- and ultra-HoLEP respectively.Source of Funding: No funding received