Laser Enucleation of the Prostate in Men with Very Large Glands ≥175 ml: A Systematic Review

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2022 Sep 1

PMID 36045851

Authors

Mehmet Yilmaz

Mustafa Karaaslan

Halil Cagri Aybal

Maximilian Ferry Von Bargen

Senol Tonyali

Tuncay Toprak

Christian Gratzke

Arkadiusz Miernik

Affiliations

Soon will be listed here.

Abstract

Background: Surgical treatment options for lower urinary tract symptoms can differ according to prostate size. There are few studies on the efficacy and safety of endoscopic enucleation of prostate (EEP) in patients with very large prostates focusing on laser as energy source. In this systematic review, we aimed to examine the efficacy and safety of laser-based EEP on prostate glands ≥150 ml.

Methods: A systematic search was conducted using Web of Science, PubMed-MEDLINE, Wiley Online Library and Cochrane Library databases with the following search terms solely or in combination: "large prostate", "laser enucleation", "laser prostatectomy"by combining PICO (population, intervention, comparison, and outcome) terms. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed.

Results: We retrieved 6 studies included 375 patients with prostate sizes ≥175 ml treated with laser-based EEP for symptomatic benign prostatic obstruction. Three studies examined Holmium laser enucleation of prostate (HoLEP) outcomes with a prostate volume (PV) >200 ml, one evaluated HoLEP outcomes with a PV of 200-299 and ≥ 300 ml, two studies evaluated HoLEP outcomes with a PV > 175 ml. We observed improvement in postoperative functional outcomes in patients with a PV > 175, >200 and >300 ml. The retreatment rate was 0-1.3% in all studies involving prostate size ≥175 ml. Most of the complications were Clavien-Dindo I (%0-9) and II (%12.7-16.6).

Conclusions: Laser-based EEP is an efficient, safe and feasible procedure even in very large prostates with good functional outcomes, low perioperative complication and retreatment rates.

Citing Articles

Safety and feasibility of En-bloc holmium laser enucleation for very large prostates (> 200 cc) with trainee involvement.

Maluf F, Bhatia A, Khandekar A, Lopategui D, Porto J, Chen R BJUI Compass. 2025; 6(1):e469.

PMID: 39877563 PMC: 11771494. DOI: 10.1002/bco2.469.

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates.

Juliebo-Jones P, Gauhar V, Castellani D, Fong K, Sofer M, Zawadzki M World J Urol. 2024; 42(1):299.

PMID: 38710824 PMC: 11074046. DOI: 10.1007/s00345-024-04959-6.

Commentary on "Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate".

Maheshwari P, Goyal A, Shrivastava P Int Neurourol J. 2023; 26(4):353-354.

PMID: 36599346 PMC: 9816445. DOI: 10.5213/inj.2244240.120.

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