Aho T., Shukla C.J.

Presented on March 23, 2007

INTRODUCTION & OBJECTIVES: Holmium Laser Enucleation of the Prostate (HoLEP) has been hailed as a new gold standard for bladder outlet surgery in men with prostates larger than 100 grams. Our objective is to investigate whether perioperative parameters, safety and efficacy of HoLEP vary depending on the prostate volume enucleated.

MATERIAL & METHODS: A prospective database has been maintained for all men undergoing HoLEP at our institution. HoLEP is performed using the Versapulse Holmium: YAG laser (Lumenis) at a power of 100 Watts and the technique described by Tan and Gilling. The first 216 consecutive patients were divided into 3 groups according to weight of the enucleated specimen: Group 1: Less than 40grams (n = 94), Group 2: 40-80grams (n = 71), Group 3: More than 80grams (n = 51). A number of parameters were compared between groups including: operative efficiency, need for post-operative irrigation, catheter and hospital time, change in serum haemoglobin and sodium, complications, success in treating urinary retention, and change in IPSS and quality of life (QOL) scores, maximal flow rates (Qmax) and post void residual volumes (PVR) at 3 months.

RESULTS: 216 patients underwent HoLEP between September 2004 and October 2006. There were no significant differences in age and ASA score between groups. More patients had an indwelling catheter pre-operatively in groups 2 and 3 (62% and 61%) than in group 1 (44%; p = 0.03). The efficiency of enucleation increased as the weight of enucleated tissue increased (Enucleation = 0.5 g/min in Group 1 and 1.3g/min in Group 3; p<0.001). There were no significant differences in rate of morcellation and catheter time. There was a statistically significant difference in length of stay between Group 1 (1 day) and Group 3 (2 days; p<0.001). Although change in serum sodium did not reach statistical significance between groups there was a mildly greater drop in serum haemoglobin in Group 3 (1.5 g/dl) compared to Group 1 (0.85 g/dl; p = 0.003) as well as a greater need for post-operative irrigation in Groups 2 and 3 (24%) as compared to Group 1 (6%, p = 0.003). Only 4 patients who were in urinary retention pre-operatively failed to void post-operatively (Group 1 = 3, Group 2 = 1, Group 3 = 0). There were similar highly significant improvements in IPSS, QOL, Qmax and PVR in all groups in those not in retention pre-operatively. There was no difference in complication rate between groups although the types of complications differed.

CONCLUSIONS: In our experience HoLEP is safe and efficacious at all prostate volumes. It is highly successful at relieving urinary retention regardless of prostate size. Prostate size does not appear to be a limiting factor in HoLEP.

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