Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum - Beyond the Abstract

We conducted an extensive study to evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) across a broad spectrum of prostate sizes.

While HoLEP is a well-established and effective treatment for enlarged prostates, there has been a notable absence of direct comparisons between small (< 40 g) and very large glands (> 200 g) in the existing literature. This knowledge gap has left urologists and patients with limited information regarding potential differences in outcomes across these distinct size categories. Our study, the largest of its kind to date, sought to address this crucial gap by encompassing the entire range of prostate sizes.

One of the key findings of our study was that HoLEP consistently demonstrated favorable voiding outcomes across all three size groups (small, medium, and very large prostates). This reaffirms the notion that HoLEP is indeed a size-independent treatment option for benign prostatic hyperplasia. Additionally, our study highlighted some noteworthy trends. For instance, patients with smaller prostates (< 40 g) exhibited a greater likelihood of transient acute urinary retention. We also observed a higher incidence of perioperative blood transfusions in patients with very large prostates (> 200 g).

Furthermore, there were trends toward a higher rate of bladder neck stenosis and urethral strictures in patients with smaller prostates, although these findings did not reach statistical significance. It is essential to recognize these trends as they can inform clinical decision-making and patient counseling.

Although there are some notable trends and differences in outcomes among different size categories, the overall efficacy and safety of HoLEP remain largely unaffected by prostate size. We believe that our findings provide a valuable contribution to the field of urology, facilitating informed treatment decisions and patient discussions regarding HoLEP as a whole.

Written by: Joao G. Porto, & Hemendra N. Shah, Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL

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