Skip Navigation
Skip to contents

KMJ : Kosin Medical Journal

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > Kosin Med J > Volume 28(2); 2013 > Article
Original Article
Mid-term Results of Holmium Laser Enucleation of the Prostate (HoLEP) for the Treatment of Benign Prostatic Hyperplasia (BPH) by a Single Surgeon
Seong Choi
Kosin Medical Journal 2013;28(2):123-129.
DOI: https://doi.org/10.7180/kmj.2013.28.2.123
Published online: January 19, 2013

Department of Urology, College of Medicine, Kosin University. Busan, Korea

Corresponding author: Seong Choi, Department of Urology, College of Medicine, Kosin University 34 Amnamdong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6253 FAX: +82-51-990-3994 E-mail: schoi@ns.kosinmed.or.kr
• Received: December 6, 2012   • Accepted: March 18, 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 785 Views
  • 5 Download
  • Objectives
    Here the author report the mid-term clinical outcomes analysis with efficacy and safety of HoLEP.
  • Methods
    From May 2010 to September 2012, 270 consecutive patients treated with HoLEP were enrolled in this study. All patients was evaluated by digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA preoperatively. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and 1, 3, 6, 12, 24 months postoperatively. The perioperative data and complications were analyzed. All procedures of HoLEP was done by a single surgeon.
  • Results
    The mean patient age at the surgery was 67.5 years (45-82), and the mean PSA was 3.7 ng/mL (0.4-19.4). Mean operation time was 73.6 minutes (30-150). Mean prostate volume was 64.3 mL (20-150) and mean resected tisssue weight was 9.3 g (2-63). Mean catheter indwelling time was 2.7 day (1-6), and mean hospital stay was 3.2 day (1-7). The blood loss was minimal, so transfusion was not needed. The baseline data were IPSS; 23.0 (7-35), QoL score; 5.4 (4-6), Qmax (mL/s); 12.5 (1.2-16.5), PVR (mL); 59 (20-250). Postoperatively, IPSS and QoL scores and PVR decreased, and Qmax increased significantly. Intraoperative complication was minor capsular perforation (n = 5). Postoperative complications were acute urinary retention (n = 9), transient incontinence (n = 17), urinary tract infection (n=4), urethral stricture (n=4) and bladder neck contracture (n = 12).
  • Conclusions
    HoLEP showed statistical improvement of clinical parameters after 1 month operation and these results sustained for 24 months regardless of prostatic size.
Table 1.
Baseline characteristics of the 270 patients who underwent HoLEP
Mean (range)
Age (years) 67.5 (45-82)
Prostatic volume (mL) 64.3 (20-150)
PSA (ng/mL) 3.7 (0.4-19.4)
Operation time (min) 73.6 (30-180)
Resected weight (gm) 9.3 (2-63)
Hb loss 0.92 (0.2-1.9)
Catheterization time (days) 2.7 (1-6)
Hospital stay (days) 3.2 (1-7)
Table 2.
Changes in clinical parameters after HoLEP
Preoperative Postop. (n = 270) 1 mo. (n = 258) 3 mo. (n = 228) 6 mo. (n = 195) 12 mo. (n = 166) 24 mo. (n = 122)
IPSS 23.0 (7-35) 10.8* (7-13) 10.5* (5-12) 10.1* (5-12) 9.6* (4-11) 8.8* (4-11)
QoL score 5.4 (4-6) 3.5* (3-5) 3.3* (3-5) 3.2* (2-5) 3.1* (2-5) 2.9* (2-5)
Qmax (ml/s) 12.5 (1.2-16.5) 22.0* (11.2-44.5) 23.1* (13.2-46.5) 23.4* (13.1-45.2) 24.2* (12.9-46.5) 24.3* (11.2-44.5)
PVR (mL) 59.0 (20-250) 28.0* (0-50) 24.0* (0-45) 23.0* (0-40) 20.0* (0-30) 18.0* (0-30)

* Compared to preoperative data, P-value of <0.05. HoLEP, holmium laser enucleation of the prostate; IPSS, International Prostate Symptom Score; QoL, quality of life; Qmax, peak urinary flow rate; PVR, postvoid residual urine; mo., months

Table 3.
Intraoperative and postoperative complications
Minor capsular perforation 5
Recatheterization due to retention 9
Transient incontinence 17
Urinary tract infection 4
Urethral stricture 4
Bladder neck contracture 12
  • 1.Kuo RL, Paterson RF, Kim SC, Siqueira Jr TM, Elhilali MM, Lingeman JE. Holmium laser enucleation of the prostate (HoLEP): A technical update. World J Surg Oncol 2003;1:6–14.PubMedPMC
  • 2.Shah HN, Sodha HS, Kharodawala SJ, Khandkar AA, Hegde SS, Bansal MB. Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int 2008;101:1536–41.ArticlePubMed
  • 3.Moody JA, Lingeman JE. Holmium laser enucleation for prostate adenoma greater than 100 gmL comparison to open prostatectomy. J Urol 2001;165:459–62.PubMed
  • 4.Gilling PJ, Fraundorfer MR. Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol 1998;8:11–5.PubMed
  • 5.Kuntz RM, Ahyai SA, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate; a randomized prospective trial in 200 patients. J Urol 2004;172:1012–6.ArticlePubMed
  • 6.Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. EurUrol 2008;53:160–6.
  • 7.Costello AJ, Bowsher WG, Bolton DM, Braslis KG, Burt J. Laser ablation of the prostate in patients with benign prostatic hypertrophy. Br J Urol 1992;69:603–8.ArticlePubMed
  • 8.Ruszat R, Seitz M, Wyler SF, Muller G, Rieken M, Bonkat G, et al. Prospective single centre comparison of 120 W diode pumped solid state high intensity system laser vaporization of the prostate and 200 W high intensive diode laser ablation of the prostate for treating benign prostatic hyperplasia. BJU Int 2009;104:820–5.ArticlePubMed
  • 9.Te AE, Malloy TR, Stein BS, Ulchaker JC, Nseyo UO, Hai MA, et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial. J Urol 2004;172:1404–8.ArticlePubMed
  • 10.Bachmann A, Ruszat R, Wyler S, Reich O, Seifert HH, Muller A, et al. Photoselective vaporization of the prostate: the basel experience after 108 procedures. Eur Urol 2005;47:798–804.ArticlePubMed
  • 11.Lerner LB, Tyson MD. Holmium laser applications of the prostate. UrolClin North Am 2009;36:485–95.
  • 12.Matlaga BR, Kim SC, Kuo RL, Watkins SL, Lingeman JE. Holmium laser enucleation of the prostate of > 125 mL. BJU Int 2006;97:81–4.ArticlePubMed
  • 13.Kuo RL, Kim SC, Lingeman JE, Paterson RF, Watkins SL, Simmons GR, et al. Holmium laser enucleation of the prostate (HoLEP): the Methodist Hospital experience with greater than 75 gm enucleation. J Urol 2003;170:149–52.PubMed
  • 14.Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, et al. A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporization and holmium laser enucleation of the prostate. Eur Urol 2009;55:1345–57.PubMed
  • 15.Tyson MD, Lerner LB. Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol 2009;23:1343–6.ArticlePubMed
  • 16.Elzayat E, Habib E, Elhilali M. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol 2006;175:1428–32.ArticlePubMed
  • 17.Kim SC, Tinmouth WW, Kuo RL, Paterson RF, Lingerman JE. Simultaneous holmium laser enucleation of the prostate and upper-tract endourologic stone procedures. J Endourol 2004;18:971–5.PubMed
  • 18.Abdel-Hakim AM, Habib EI, El-Feel AS, Elbaz AG, Fayad AM, Abdel-Hakim MA, et al. Holmium laser enucleation of the prostate: initial report of the first 230 Egyptian cases performed in a single center. Urology 2010;76:448–52.ArticlePubMed
  • 19.Peterson MD, Matlaga BR, Kim SC, Kuo RL, Soergel TM, Watkins SL, et al. Holmium laser enucleation of the prostate for men with urinary retention. J Urol 2005;174:998–1001.ArticlePubMed
  • 20.Shah HN, Mahajan AP, Sodha HS, Hegde SS, Mohile PD, Bansal MB. Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol 2007;177:1468–74.ArticlePubMed
  • 21.Shah HN, Mahajan AP, Hegde SS, Bansal MB. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int 2007;100:94–101.ArticlePubMed
  • 22.Vavassori I, Valenti S, Naspro R, Vismara A, Dell'Acqua V, Manzetti A, et al. Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol 2008;53:599–604.ArticlePubMed
  • 23.Seki N, Mochida O, Kinukawa N, Sagiyama K, Naito S. Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol 2003;170:1847–50.ArticlePubMed
  • 24.Tan AH, Gilling PJ, Kennet KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 2003;170:1270–4.ArticlePubMed
  • 25.Kuo RL, Paterson RF, Siqueira TM Jr, Watkins SL, Simmons GR, Steele RE, et al. Holmium laser enucleation of the prostate: morbidity in a series of 206 patients. Urology 2003;62:59–63.ArticlePubMed
  • 26.Takiuchi H, Nakao A, Ihara H. Prevention of transient urinary incontinence in peri-operative period of modified holmium laser enucleation of the prostate (HoLEP). Hinokika Kiyo 2008;54:475–8.
  • 27.Du C, Jin X, Bai F, Qiu Y. Holmium laser enucleation of the prostate: the safety, efficacy, and learning experience in China. J Endourol 2008;22:1031–6.ArticlePubMed
  • 28.Jeong CW, Oh JK, Cho MC, Bae JB, O SJ. Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate. Int Braz J Urol 2012;38:362–72.ArticlePubMed

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy
        Close
      • Download Citation
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Mid-term Results of Holmium Laser Enucleation of the Prostate (HoLEP) for the Treatment of Benign Prostatic Hyperplasia (BPH) by a Single Surgeon
        Kosin Med J. 2013;28(2):123-129.   Published online January 19, 2013
        Close
      • XML DownloadXML Download

      KMJ : Kosin Medical Journal