EAU 2018: Holmium Laser Enucleation of the Prostate (HoLEP) in Large-Sized Prostates
Dr. Placer and team created a database of a total of 414 patients going back to 2006 with preoperative prostate volumes of greater than 100 cm3 (average was 135.4 cm3). The mean age of the patients was 69.5 +/- 7.6 years with 37 of 414 patient being over the age of 80. The mean follow-up times for the patients was 804 +/- 704.3 days. The indications for surgery for nearly all patients included in the study were LUTS refractory to medical therapy or refractory urinary retention.
HoLEP was preceded by dilation with metal sounds or internal urethrotomy in 58 patients and by transurethral holmium laser lithotripsy of bladder calculi in 45 patients. For 7 patients, HoLEP was followed by transurethral resection of bladder tumor. The mean weight of the enucleated adenomas was 96.5 g. Pathology showed prostate cancer in 9 of the cases. Patients were followed up at 3, 12, 24, 36, 48, and 60 months. At 24 months after surgery there was a significant increase in Qmax and a significant reduction in IPSS, Qol, PSA and PRV scores. Many patients experienced minor complications, but none experienced fluid balance disturbance or dilutional hyponatremia. However, 11 of the patients had undergone reoperation because of urethral strictures, 1 patient due to persistence of the adenoma and 7 patients had incontinence.
Dr. Placer concluded by stating that for cases that involve enlarged prostate HoLEP can be done safely and efficiently as an alternative to open prostatectomy.
Presented by: J. Placer, MD, Hospital vall d'Hebron, Dept. of Urology, Barcelona, Spain
Co Authors: Placer J., Salvador C., Lorente D., Schwartzmann I., López Del Campo R., Planas J., Celma A., Trilla E., Regis L., Morote J.
Author Information: Hospital vall d'Hebron, Dept. of Urology, Barcelona, Spain
Written by: Renai Yoon, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark