Holmium Laser Enucleation of the Prostate: Surgical, Functional, and Quality-of-life Outcomes Upon Extended Follow-up

Overview

Journal Int Braz J Urol

Specialty Urology

Date 2016 Jun 4

PMID 27256184

Citations 10

Authors

Ilter Alkan

Hakan Ozveri

Yigit Akin

Tumay Ipekci

Yusuf Alican

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH).

Materials And Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05.

Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up.

Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

Citing Articles

Predictive factors of stress urinary incontinence after Holmium Laser Enucleation of the Prostate: a magnetic resonance imaging-based retrospective study.

Fan X, Zhang J, Zhu H, Huang F, Shadike A, Jiang C Transl Androl Urol. 2024; 13(9):1775-1785.

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High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group.

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Omentin-1 inhibits the development of benign prostatic hyperplasia by attenuating local inflammation.

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Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients - A Narrative Review.

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Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate-a comparison of patients with lower urinary tract symptoms and urinary retention.

Trotsenko P, Wetterauer C, Grimsehl P, Moltgen T, Meierhans S, Manka L Lasers Med Sci. 2020; 36(7):1397-1402.

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References

Gupta N, Anand A . Comparison of TURP, TUVRP, and HoLEP. Curr Urol Rep. 2009; 10(4):276-8. DOI: 10.1007/s11934-009-0045-4. View

Akin Y, Gulmez H, Ucar M, Yucel S . The effect of first dose of tamsulosin on flow rate and its predictive ability on the improvement of LUTS in men with BPH in the mid-term. Int Urol Nephrol. 2013; 45(1):45-51. DOI: 10.1007/s11255-012-0377-8. View

Gilling P, Wilson L, King C, Westenberg A, Frampton C, Fraundorfer M . Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2011; 109(3):408-11. DOI: 10.1111/j.1464-410X.2011.10359.x. View

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

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

Bozlu M, Doruk E, Akbay E, Ulusoy E, Cayan S, Acar D . Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom Score. Int J Urol. 2002; 9(8):417-21. DOI: 10.1046/j.1442-2042.2002.00491.x. View

Keoghane S, Lawrence K, Gray A, Doll H, Hancock A, Turner K . A double-blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3-year follow-up. BJU Int. 2000; 85(1):74-8. DOI: 10.1046/j.1464-410x.2000.00407.x. View

Sun N, Fu Y, Tian T, Gao J, Wang Y, Wang S . Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial. Int Urol Nephrol. 2014; 46(7):1277-82. DOI: 10.1007/s11255-014-0646-9. View

Elmansy H, Kotb A, Elhilali M . Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol. 2011; 186(5):1972-6. DOI: 10.1016/j.juro.2011.06.065. View

10.

Ritter M, Krombach P, Bolenz C, Martinschek A, Bach T, Haecker A . Standardized comparison of prostate morcellators using a new ex-vivo model. J Endourol. 2011; 26(6):697-700. DOI: 10.1089/end.2011.0536. View

11.

Jeong M, Ha S, Lee C, Cho M, Kim S, Paick J . Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study. Korean J Urol. 2012; 53(2):104-8. PMC: 3285704. DOI: 10.4111/kju.2012.53.2.104. View

12.

Krambeck A, Handa S, Lingeman J . Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2012; 189(1 Suppl):S141-5. DOI: 10.1016/j.juro.2012.11.027. View

13.

Kuntz R, Lehrich K, Ahyai S . Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2007; 53(1):160-6. DOI: 10.1016/j.eururo.2007.08.036. View

14.

van Rij S, Gilling P . In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new 'gold standard'. Curr Urol Rep. 2012; 13(6):427-32. DOI: 10.1007/s11934-012-0279-4. View

15.

Klett D, Tyson 2nd M, Mmeje C, Nunez-Nateras R, Chang Y, Humphreys M . Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study. Urology. 2014; 84(2):421-6. DOI: 10.1016/j.urology.2014.04.042. View

16.

Cornu J, Terrasa J, Lukacs B . Ex vivo comparison of available morcellation devices during holmium laser enucleation of the prostate through objective parameters. J Endourol. 2012; 28(10):1237-40. DOI: 10.1089/end.2011.0454. View

17.

Tan A, Gilling P, Kennett K, Fletcher H, Fraundorfer M . Long-term results of high-power holmium laser vaporization (ablation) of the prostate. BJU Int. 2003; 92(7):707-9. DOI: 10.1046/j.1464-410x.2003.04474.x. View

18.

Shah H, Mahajan A, Hegde S, Bansal M . Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int. 2007; 100(1):94-101. DOI: 10.1111/j.1464-410X.2007.06867.x. View

19.

Netsch C, Bach T . Vaporization vs. enucleation techniques for BPO: do we have a standard?. Curr Opin Urol. 2014; 25(1):45-52. DOI: 10.1097/MOU.0000000000000125. View

20.

Gilling P, Aho T, Frampton C, King C, Fraundorfer M . Holmium laser enucleation of the prostate: results at 6 years. Eur Urol. 2007; 53(4):744-9. DOI: 10.1016/j.eururo.2007.04.052. View