Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

No AccessJournal of UrologyVoiding Dysfunction1 Jan 2013Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasiais accompanied byExperience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia Amy E. Krambeck, Shelly E. Handa, and James E. Lingeman Amy E. KrambeckAmy E. Krambeck More articles by this author , Shelly E. HandaShelly E. Handa More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.11.027AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. Materials and Methods: From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Results: Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Conclusions: Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results. References 1 : A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol2004; 171: 1773. Link, Google Scholar 2 : Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm: a randomized prospective trial of 120 patients. J Urol1465; 168: 1465. Google Scholar 3 : Holmium laser treatment of benign prostatic hyperplasia: an update. Curr Opin Urol2007; 17: 27. Google Scholar 4 : Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol2004; 172: 1012. Link, Google Scholar 5 : Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol2007; 52: 1456. Google Scholar 6 : Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with benign prostatic hyperplasia. J Urol2004; 172: 1926. Google Scholar 7 : Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1 year follow-up. J Urol1999; 162: 1640. Link, Google Scholar 8 : A randomized trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol2006; 50: 569. Google Scholar 9 : Holmium laser enucleation of the prostate: results at 6 years. Eur Urol2008; 53: 744. Google Scholar 10 : Holmium laser enucleation of the prostate (HoLEP): the Methodist hospital experience with greater than 75 gram enucleations. J Urol2003; 170: 149. Link, Google Scholar 11 : Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology2005; 66: 108. Google Scholar 12 : Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol2006; 49: 87. Google Scholar 13 : Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomized clinical trial. Eur Urol2008; 53: 160. Google Scholar 14 : Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol2006; 175: 1428. Link, Google Scholar 15 : Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol2007; 52: 1465. Google Scholar 16 : Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study. Urology2001; 57: 454. Google Scholar 17 : Systematic review and economic modeling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess2008; 12: 169. Google Scholar 18 : Holmium laser enucleation of the prostate (HoLEP): a technical update. World J Surg Oncol2003; 1: 6. Google Scholar 19 : Current techniques for laser prostatectomy—PVP and HoLEP. Arch Esp Urol2008; 61: 1005. Google Scholar 20 : Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol2005; 174: 1344. Link, Google Scholar Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLee M, Assmus M, Agarwal D, Large T and Krambeck A (2021) A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™Urology Practice, VOL. 8, NO. 6, (624-629), Online publication date: 1-Nov-2021.Kaplan S (2020) Re: Holmium Laser Enucleation of the Prostate in Benign Prostate Hyperplasia Patients with or without Oral Antithrombotic Drugs: A Meta-AnalysisJournal of Urology, VOL. 204, NO. 5, (1070-1070), Online publication date: 1-Nov-2020.Johnsen N, Kammann T, Marien T, Pickens R and Miller N (2015) Comparison of Holmium Laser Prostate Enucleation Outcomes in Patients with or without Preoperative Urinary RetentionJournal of Urology, VOL. 195, NO. 4 Part 1, (1021-1026), Online publication date: 1-Apr-2016.Large T, Borofsky M and Lingeman J (2015) Re: Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes and Re: GreenLight™ Laser (XPS) Photoselective Vapo-Enucleation versus Holmium Laser Enucleation of the Prostate for the Treatment of Symptomatic Benign Prostatic Hyperplasia: A Randomized Controlled StudyJournal of Urology, VOL. 195, NO. 1, (228-231), Online publication date: 1-Jan-2016.Related articlesJournal of Urology21 Jan 2010Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia Volume 189Issue 1SJanuary 2013Page: S141-S145 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordslaser therapytransurethral resection of prostateprostatic hyperplasiaprostateprostatectomyMetricsAuthor Information Amy E. Krambeck More articles by this author Shelly E. Handa More articles by this author James E. Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...