Kuntz R.M., Lehrich K.

Presented on March 22, 2007

INTRODUCTION & OBJECTIVES: Introduction and objectives: Of all BPH treatment modalities, open prostatectomy (OP) offers the highest probability of symptomatic improvement and the lowest failure rate, but also has the highest rate of complications. HoLEP offers a low perioperative morbidity and is suitable for prostate glands of all sizes. Randomized trials comparing HoLEP with OP are rare and long-term results have never been published. We report 5 year follow-up results.

MATERIAL & METHODS: Material and methods: 120 patients with prostates larger than 100 g on TRUS were randomized to either HoLEP or OP, 60 patients to each group. HoLEP was performed at 2.0 J, 40-50 Hz, 80-100 W, with reusable 550 nm laser fibers. The prostatic lobes were dissected away from the prostatic capsule in exactly the same plane in which the surgeon’s index finger moves when performing OP. Postoperative assessments included measurement of AUA symptom scores, peak flow rates, post-void urine volumes (PUV) and complications, and were performed at 1, 3, 6, 12, 18, 24, 36, 48 and 60 months.

RESULTS: Results: Early results (HoLEP vs OP): There was no significant difference between the HoLEP and OP group in patient age (69 vs 71 yrs), prostate volume (115 vs 113 g) and resected weight (94 vs 96 g). Perioperative morbidity (blood loss, length of catheter time and hospital stay) was significantly lower in the HoLEP group (p < 0.001). Early complication rates and improvements in AUA symptom scores, peak flow rates and PUV’s were similar between the two groups (R M Kuntz et al. J. Urol. 2002; 168: 1465-9). Results at 5 years postoperatively (HoLEP vs. OP): A total of 84 of the120 patients completed the 5 yrs. follow-up assessment (45 vs 39). Mean AUA symptom score preop. 22 vs 21, 5 yrs postop. 3 vs 3, mean peak flow rate preop. 4 vs 4 ml/sec, 5 yrs postop. 21 vs 24 ml/sec, mean residual volume preop. 280 vs 292 ml, 5 yrs postop. 12 vs 5 ml. Late complications: urethral stricture and visual urethrotomy 2 vs 1, bladder neck contracture and Ho:YAG laser incision 1 vs 3.

CONCLUSIONS: Conclusions: HoLEP compares favourably with open prostatectomy. The perioperative morbidity is significantly lower, and at 5 years postoperatively, the long-term improvement of micturition outcome is equally good and lasting. HoLEP proved to be a true endourological alternative to OP.

UroToday.com Full Conference Coverage

Please log-in or register in order to submit comments.

Powered by AkoComment!