Transurethral Holmium Laser Enucleation of the Prostate (HoLEP) – A Prospective Study on 100 Patients with One Year Follow-up

Abstract

Summary Purpose: Prostate tissue can be incised with high-powered holmium:YAG lasers. In patients with benign prostatic hyperplasia and bladder outlet obstruction, obstructing tissue can be resected and ablated. In this prospective study, the efficiency of holmium laser enucleation of the prostate was to be evaluated. Materials and Methods: A total of 100 urodynamically obstructed patients underwent high-powered holmium laser enucleation of the prostate. All patients were assessed preoperatively and at intervals of one week, two weeks, one month, three months, six months and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate and post-void residual urine measurement. All perioperative and postoperative complications were recorded. Results: The mean preoperative prostate weight was 61.5 (20–140) grams, 30 patients had prostates larger than 80 grams. The mean retrieved tissue was 40 (10–90) grams. The operation time was 101 min. In 5 patients, incidental carcinoma of the prostate was detected. None of the patients required blood transfusions. The median postoperative catherization and hospital stay were 24 and 48 hours, respectively. Holmium laser enucleation of the prostate induced a significant, pronounced, immediate and lasting improvement of symptom score, peak urinary flow rate and post-void residual urine. Postoperative complications were arterial bleeding in one case, incontinence in one case, urethral strictures and bladder neck contractures in two cases each. Conclucions: Holmium laser enucleation of the prostate appears to be an effective treatment for bladder outlet obstruction due to benign prostatic hyperplasia. It can be applied in glands of virtually all sizes.