Safety and Feasibility of Concomitant Surgery During Holmium Laser Enucleation of the Prostate (HoLEP)

Overview

Journal World J Urol

Specialty Urology

Date 2014 Feb 7

PMID 24500193

Citations 6

Authors

Amar Patel

Rafael Nunez

Chinedu O Mmeje

Mitchell R Humphreys

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the feasibility and outcomes associated with performing simultaneous surgical procedures during holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia and concomitant urologic conditions.

Methods: A retrospective review of patients that underwent a HoLEP was performed. Patients undergoing a concomitant procedure at the time of HoLEP were selected and stratified based on complexity of the secondary procedure (simple, intermediate, and complex) and matched based on age and prostate volume to patients undergoing only a HoLEP. Baseline characteristics, preoperative, operative, and postoperative outcomes were collected.

Results: A total of 372 HoLEPs were performed. Thirty-eight (10.2 %) patients underwent concomitant procedures at the time of HoLEP. Compared to the simple and intermediate secondary surgical procedures, the matched control group that underwent a HoLEP alone did not demonstrate statistically significant differences in the preoperative, operative, or postoperative outcomes. Patients with a complex secondary surgical procedure at the time of HoLEP had statistically significant differences in operative time (221 vs. 65 min, p = 0.007), estimated blood loss (92 vs. 33 mL, p = 0.012), catheter time (8.5 vs. 1 day, p = 0.041), and length of hospitalization (2 vs. 1 day, p = 0.032) compared to the control group.

Conclusions: Obstructive voiding symptoms secondary to BPH are common in older patients and may coincide with other concomitant lower urinary tract pathology that may require surgical intervention. Rather than staging surgical interventions, it appears that definitive treatment for BPH with HoLEP is safe and efficacious in those patients that also require secondary procedures.

Citing Articles

Streamlined surgical approach for coexistent urethral stricture and benign prostatic enlargement: feasibility, safety and patency results.

Schernuk J, Tinajero J, Tirapegui F, Gonzalez M, Giudice C, Favre G World J Urol. 2024; 42(1):594.

PMID: 39455449 DOI: 10.1007/s00345-024-05306-5.

Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review.

Yilmaz M, Karaaslan M, Polat M, Tonyali S, Aybal H, Sirin M World J Urol. 2023; 41(11):2949-2958.

PMID: 37689604 PMC: 10632304. DOI: 10.1007/s00345-023-04594-7.

Temperature assessment study of ex vivo holmium laser enucleation of the prostate model.

Yilmaz M, Heuring C, Dressler F, Suarez-Ibarrola R, Gratzke C, Miernik A World J Urol. 2022; 40(7):1867-1872.

PMID: 35614278 PMC: 9236967. DOI: 10.1007/s00345-022-04041-z.

Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study.

Acikgoz O, Yilmaz M, Aybal H, Yilmaz S, Gazel E, Yalcin S Cent European J Urol. 2022; 74(4):535-540.

PMID: 35083073 PMC: 8771128. DOI: 10.5173/ceju.2021.0204.

Holmium laser enucleation of the prostate: patient selection and perspectives.

Marien T, Kadihasanoglu M, Miller N Res Rep Urol. 2016; 8:181-192.

PMID: 27800470 PMC: 5085273. DOI: 10.2147/RRU.S100245.

References

Kacker R, Williams S . Endourologic procedures for benign prostatic hyperplasia: review of indications and outcomes. Urol J. 2011; 8(3):171-6. View

Ahyai S, Gilling P, Kaplan S, Kuntz R, Madersbacher S, Montorsi F . Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010; 58(3):384-97. DOI: 10.1016/j.eururo.2010.06.005. View

Ahyai S, Lehrich K, Kuntz R . Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol. 2007; 52(5):1456-63. DOI: 10.1016/j.eururo.2007.04.053. View

Girman C, Jacobsen S, Guess H, Oesterling J, Chute C, Panser L . Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. 1995; 153(5):1510-5. DOI: 10.1016/s0022-5347(01)67448-2. View

Bushman W . Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am. 2009; 36(4):403-15, v. DOI: 10.1016/j.ucl.2009.07.003. View

Schwartz B, Stoller M . The vesical calculus. Urol Clin North Am. 2000; 27(2):333-46. DOI: 10.1016/s0094-0143(05)70262-7. View

Kim S, Tinmouth W, Kuo R, Paterson R, Lingeman J . Simultaneous holmium laser enucleation of prostate and upper-tract endourologic stone procedures. J Endourol. 2005; 18(10):971-5. DOI: 10.1089/end.2004.18.971. View

Chong T, Li Y, Wang Z, Shi T, Zhang P . [Simultaneous treatment for benign prostate hyperplasia and its concomitant diseases]. Zhonghua Nan Ke Xue. 2006; 12(6):534-6. View

Shah H, Hegde S, Shah J, Mahajan A, Bansal M . Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature. BJU Int. 2006; 99(3):595-600. DOI: 10.1111/j.1464-410X.2006.06570.x. View

10.

Malaeb B, Yu X, McBean A, Elliott S . National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012; 79(5):1111-6. PMC: 3415208. DOI: 10.1016/j.urology.2011.11.084. View

11.

Griebling T . Reconstructive urology and geriatrics: issues in older adults. Curr Opin Urol. 2009; 19(6):577-81. DOI: 10.1097/MOU.0b013e3283310697. View

12.

Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P . Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008; 180(1):246-9. DOI: 10.1016/j.juro.2008.03.058. View

13.

Fenter T, Naslund M, Shah M, Eaddy M, Black L . The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006; 12(4 Suppl):S90-8. View

14.

Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F . A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009; 55(6):1345-57. DOI: 10.1016/j.eururo.2009.03.070. View

15.

Luo S, Lin Y, Zhang W . Does simultaneous transurethral resection of bladder tumor and prostate affect the recurrence of bladder tumor? A meta-analysis. J Endourol. 2010; 25(2):291-6. DOI: 10.1089/end.2010.0314. View

16.

Yin L, Teng J, Huang C, Zhang X, Xu D . Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol. 2012; 27(5):604-11. DOI: 10.1089/end.2012.0505. View

17.

Humphreys M, Miller N, Handa S, Terry C, Munch L, Lingeman J . Holmium laser enucleation of the prostate--outcomes independent of prostate size?. J Urol. 2008; 180(6):2431-5. DOI: 10.1016/j.juro.2008.08.019. View

18.

Fraundorfer M, Gilling P . Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol. 1998; 33(1):69-72. DOI: 10.1159/000019535. View

19.

Singh I, Hudson J, Hemal A . Robot-assisted laparoscopic prostatectomy for a giant prostate with retrieval of vesical stones. Int Urol Nephrol. 2010; 42(3):615-9. DOI: 10.1007/s11255-009-9695-x. View

20.

Mandeville J, Gnessin E, Lingeman J . New advances in benign prostatic hyperplasia: laser therapy. Curr Urol Rep. 2010; 12(1):56-61. DOI: 10.1007/s11934-010-0153-1. View