Critical Analysis of a Multicentric Experience with Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: Outcomes and Complications of Ten Years of Routine Clinical Practice.

To assess the perioperative outcome of holmium laser enucleation of the prostate (HoLEP) in real-life practice and investigate the factors influencing safety and efficacy of the technique.

Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP in 10-year routine practice in three hospitals. Analyzed variables included preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. PSA, Qmax, IPSS), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early post-operative outcomes (change in blood parameters, catheterization time, length of hospital stay) and 12-month follow-up outcomes (change in IPSS, PSA, Qmax).

The analysis included 963 patients between 48 and 91 years old with prostates ranging 35 to 247 mL (mean 91 mL). Mean (SD) operation time was 77 (29) min, and length of hospital stay and catheterization time were 4 (2) and 1.3 (2) days, respectively. Fifty-six patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or TURP due to intraoperative complications. Patients experienced a significant decrease of hemoglobin and hematocrit, but no differences were observed between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and < than 100 mL. The concomitant removal of bladder calculi and having a prostate ≥100 mL resulted in a higher operation time but did not influenced the safety and efficacy outcomes.

HoLEP is suitable for real-life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, blather lithiasis or a prostate ≥100 mL.

BJU international. 2020 Feb 05 [Epub ahead of print]

Javier Romero-Otero, Borja García-Gómez, Lucía García-González, Esther García-Rojo, Pablo Abad-López, Juan Justo-Quintas, José Duarte Ojeda, Alfredo Rodríguez Antolín

Hospital Universitario, 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain.