Korean J Urol.  2010 Sep;51(9):619-624.

Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: Effectiveness, Safety, and Overcoming of the Learning Curve

• Hwang JC
• Park SM
• Lee JB

Abstract

PURPOSE
To examine the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the surgical treatment of benign prostatic hyperplasia and to estimate the time to overcome the learning curve.
MATERIALS AND METHODS
From May 2008 to October 2009, 164 consecutive patients treated with HoLEP were enrolled in this study. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and at 6 weeks and 3, 6, 12, and 18 months postoperatively. The 164 study subjects were divided into 3 groups (group 1 the first 50 patients treated, group 2 the second 50, and group 3 the third 64), and perioperative data and complications were analyzed in these groups to determine the learning curve. In addition, the inverse and upward techniques were compared in terms of the effects and the stability of morcellation.
RESULTS
The mean patient age was 69 years, and the average operation time was 62 minutes (range, 20-208 minutes). Mean prostate volume was 54.2 ml and mean resected tissue weight was 18.6 g. Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence (8.5%), urinary retention (4.3%), hematuria (3.0%), urinary tract infection (1.2%), and urethral stricture (0.6%), and intraoperative complications were minor capsular perforation (4%) and bladder injury (8%).
CONCLUSIONS
HoLEP was found to be effective and safe regardless of prostate size. We recommend that a systematic educational program be established to reduce the learning curve.

Keyword

Holmium; Lasers; Prostate; Prostatic hyperplasia

MeSH Terms

Hematuria
Holmium
Humans
Intraoperative Complications
Lasers, Solid-State
Learning
Learning Curve
Postoperative Complications
Prostate
Prostatic Hyperplasia
Urethral Stricture
Urinary Bladder
Urinary Retention
Urinary Tract Infections
Holmium

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