EAU 2018: Holmium Laser Enucleation of the Prostate is Effective and Safe in all Prostate Sizes

Copenhagen, Denmark (UroToday.com) Danielle Whiting, clinical urology trainee from the Tunbridge Wells NHS Trust in Maidstone, United Kingdom, described her study on the application of Holmium laser enucleation of the prostate (HoLEP) in several types of lower urinary tract symptoms (LUTS). Miss Whiting’s stance on the procedure was that HoLEP is effective and safe in small and large prostate sizes with men suffering from these symptoms. In regard to larger prostate sizes, surgeons most often use HoLEP as their gold standard procedure while favoring transurethral resection of the prostate (TURP) for smaller prostatic conditions. In this study, the outcomes and complications from a single center were sought to determine whether HoLEP was in fact beneficial for small sized prostates in addition to large sized prostates. 

A retrospective analysis of a prospective database from a single center was used to extract patient data of those who were underwent HoLEP procedures for the treatment of LUTS between December 2003 to March 2017. The data was divided according to the weight of prostatic tissue collected following surgical ablation; this data was divided into two groups: above 80 grams and up to 80 grams. Upon completion of the database analysis, 1016 cases of HoLEP was determined to have occurred at the center. 841 patients (82.8%) had a prostatic resected weight ≤ 80 grams, 70 patients (10.3%) had prostatic weight > 80 grams, and 105 patients (10.3%) had no weight recorded. 

Of the majority of the procedures performed, preoperative retention was found in 69.2% of patients with > 80 grams of resected tissue as compared to 39.6% in ≤ 80 gram patients. Additionally, there was a significant amount of urethral strictures in patients with ≤ 80 grams of prostate tissue resected. Postoperative flow rates were shown to be significantly greater in both groups following HoLEP. In closing, Miss Whiting determined that HoLEP is a safe and effective procedure for LUTS in patients with small and large prostates. Furthermore, she explained that the stricture formation rate of HoLEP in this study is comparable to TURP. With the known benefits of HoLEP and its low complication rate, this procedure should be considered the gold standard for all LUTS operations. 

Presented by: Danielle Whiting 

Co-Authors: Guest K. , Penev B. , Cynk M.
Author Information: Maidstone and Tunbridge Wells NHS Trust, Dept. of Urology, Maidstone, United Kingdom

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark
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