Initial Experience in the First 120 Cases of Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: Focusing on the Technique

Choi, Seong

Abstract

OBJECTIVES
To describe the surgical technique according to personal experience, the effectiveness and safety of HoLEP. MATERIALS & METHODS: From May 2010 to April 2011, 120 consecutive patients treated with HoLEP were enrolled in this study. All patients was evaluated by digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA preoperatively. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and 3 months postoperatively. The perioperative data and complications were analyzed. All procedures of HoLEP was done by single surgeon.
RESULTS
The mean patient age was 68.0 (50-82), and the average operation time was 71.6 minutes (range, 30-150). Mean prostate volume was 54.1 ml (range, 20-120) and mean resected tissue weight was 7.9 g (range, 2-30). Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence, urinary retention, hematuria, urinary tract infection, urethral stricture and bladder neck contracture, and intraoperative complication was minor capsular perforation. HoLEP is a method that may completely remove prostatic adenoma tissues. In particular, its clinical effectiveness is excellent regardless of prostatic size, and it is effective even in cases with prostate volume of 100 ml or more. However, about 50 cases are needed to reach the experienced level.
CONCLUSIONS
HoLEP was found to be effective and safe regardless of prostatic size. The author believe HoLEP is a size independent gold standard for BPH surgery.