Holmium Laser Enucleation of the Prostate

Abstract

Introduction:

Holmium laser enucleation of the prostate (HoLEP) is a novel surgical alternative for the treatment of bladder outlet obstruction (BOO) caused by benign prostatic growth. The results of randomized studies and case series have confirmed that HoLEP achieves immediate relief of BOO. The improvement in symptoms and flow parameters is maintained throughout the medium term and is associated with less morbidity than conventional surgery. However, the shortage of urologists with relevant experience and the approach's technical difficulty have limited its use.

Materials and Methods:

In this video, we describe in detail the technique that we use in our center to perform HoLEP. We describe our modifications to the surgical technique from the original description by Gilling, ¹ which are the results of our experience after more than 500 procedures. ² We emphasize the technical details that facilitate surgery and avoid complications.

Results and Conclusions:

HoLEP is a reproducible procedure that has outstanding functional results. Proper learning of the technique is key to the success of the surgery. Learning the technique allows the surgeon to reduce operative time and minimize the rate of complications. Retrograde dissection of the apical lobes from the verumontanum to the bladder neck, as shown in the video, reduces the risk of injuring the external sphincter.

José Placer received speaker honoraria from Lumenis. None of the remaining authors have any conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the article. No funding or other financial support was received.

Runtime of video: 10 mins