Korean J Urol.  2015 Mar;56(3):218-226. 10.4111/kju.2015.56.3.218.

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

• Kim M
• Piao S
• Lee HE
• Kim SH
• Oh SJ

• KMID: 2133290
• DOI: http://doi.org/10.4111/kju.2015.56.3.218

Abstract

PURPOSE
To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates.
MATERIALS AND METHODS
Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL< or =TPV<200 mL), and group C (TPV> or =200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery.
RESULTS
A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, +/-7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7+/-36.9 mL and 4.15+/-4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture.
CONCLUSIONS
HoLEP in patients with an extremely large prostate can be performed efficiently and safely.

Keyword

Laser therapy; Prostate; Prostatic hyperplasia; Transurethral resection of prostate

MeSH Terms

Aged
Aged, 80 and over
Holmium
Humans
Laser Therapy/*adverse effects
Lasers, Solid-State/*therapeutic use
Male
Middle Aged
Organ Size
*Postoperative Complications
Prostate/pathology/*surgery
Prostate-Specific Antigen/blood
Prostatic Hyperplasia/*surgery
Quality of Life
Retrospective Studies
Seoul
Transurethral Resection of Prostate/*methods
Treatment Outcome
Holmium
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Technical challenges in enucleation of an extremely large prostate. (A) The enlarged adenomas frequently protrude into the urethral lumen; therefore, a bottleneck is commonly formed at the bladder neck level, and intravesical prostatic protrusion of the extremely enlarged prostate is also common. (B) Occasionally, insufficient cystoscopic length owing to the large volume of the prostate is encountered. The too narrow space and acute angle from the scope continuously disturb the cystoscopic view. (C) Owing to the presence of large and multiple adenoma nodules, finding a proper capsule plane is difficult, and the range of cystoscopic manipulation is always restricted. (D) Furthermore, pushing the enucleated adenoma tissue into the bladder may also be difficult. Scan this QR code to see the accompanying video, or visit www.kjurology.org or http://youtu.be/F77Hp8x4iZU.

• 

  Fig. 2 Correlation between total prostate volume and enucleation efficacy.

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