Holmium laser enucleation of the prostate: A single-centre case series of 1000 patients

Abstract

Objective:

To describe the short and long-term complications of over 1000 cases of Holmium laser enucleation of the prostate (HoLEP) in a single centre.

Methods:

A prospective database of all HoLEP procedures performed between December 2003 and March 2017 was analysed.

Results:

A total of 1016 HoLEP procedures were performed. Median patient age was 72 years (range 41–95). There was a significant improvement in urinary flow, post-void residual volume, IPSS and QoL score (p < 0.0001). Pre-operative acute urinary retention was present in 403 patients (39.7%). Post-operatively five patients (1.2%) continued with a long-term catheter. Early and late complications consisted of failed initial voiding trial (10.6%), stress incontinence (transient 6.5%; persistent 0.3%), frequency/dysuria (5.6%), urinary tract infection (5.3%), urethral stricture (4.8%), submeatal stenosis (1.9%), return to theatre (1.5%), bladder neck stenosis (1.3%), bleeding (1.2%), epididymitis (0.7%), confusion (0.3%), transurethral resection of the prostate conversion (0.2%), ureteric obstruction (0.2%), vomiting (0.2%), anuric renal failure (0.1%), chest infection (0.1%), chest pain (0.1%), myocardial infarction (0.1%), rectoprostatic fistula (0.1%), supraventricular tachycardia (0.1%) and urinary sepsis (0.1%). Five-year reoperation rate was 3.7%.

Conclusion:

HoLEP is a safe treatment for bladder outflow obstruction secondary to an enlarged prostate. It is associated with few early and late complications and has a low reoperation rate.

Level of evidence:

Keywords

Holmium laser post-operative complications benign prostate disorders prostatic hyperplasia transurethral resection of prostate

Get full access to this article

View all access options for this article.

References

Madersbacher

Marberger

. Is transurethral resection of the prostate still justified? BJU Int 1999; 83: 227–237.

Madersbacher

Lackner

Brӧsner

, et al. Prostate Study Group of the Austrian Society of Urology. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: A nation-wide, long term analysis of 23,123 cases. Eur Urol 2005; 47: 499–504.

Rassweiler

Teber

Kuntz

, et al. Complications of transurethral resection of the prostate (TURP) – incidence, management, and prevention. Eur Urol 2006; 50: 969–979.

Teo

Lee

HSS

. An update on transurethral surgery for benign prostatic obstruction. Asian J Urol 2017; 4: 195–198.

Reich

Gratzke

Stief

. Techniques and long-term results of surgical procedures for BPH. Eur Urol 2006; 49: 970–978.

Cynk

. Holmium laser enucleation of the prostate: A review of the clinical trial evidence. Ther Adv Urol 2014; 6: 62–73.

Gilling

Cass

Cresswell

, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J Endourol 1996; 10: 459–461.

Fraundorfer

Gilling

. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur Urol 1998; 33: 69–72.

Michalak

Tzou

Funk

. HoLEP: The gold standard for the surgical management of BPH in the 21st Century. Am J Clin Exp Urol 2015; 3: 36–42.

10.

Gilling

. Holmium Laser Enucleation of the Prostate (HoLEP). BJU Int 2007; 101: 131–142.

11.

Cynk

Georgiadis

Moore

, et al. Day-case Holmium laser enucleation of the prostate. J Clin Urol 2015; 8: 268–273.

12.

Dindo

Demartines

Clavien

. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205–213.

13.

Elzayat

Elhilali

. Holmium Laser Enucleation of the Prostate (HoLEP): Long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol 2007; 52: 1465–1471.

14.

Kuntz

Lehrich

Ahyai

. 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. Eur Urol 2008; 53: 160–166.

15.

Elmansy

Kotb

Elhilali

. Holmium laser enucleation of the prostate: Long-term durability of clinical outcomes and complication rates during 10 years of follow up. J Urol 2011; 186: 1972–1976.

16.

Gilling

Wilson

King

, et al. Long-term results of a randomized trial comparing Holmium laser enucleation of the prostate and transurethral resection of the prostate: Results at 7 years. BJU Int 2012; 109: 408–411.

17.

. Measuring change in prostate size after holmium laser enucleation: a prospective study. Investig Clin Urol 2017; 58: 200–204.

18.

Pickard

Emberton

Neal

. The management of men with acute urinary retention. Br J Urol 1998; 81: 712–720.

19.

Gilling

Aho

Frampton

, et al. Holmium laser enucleation of the prostate: Results at 6 years. Eur Urol 2008; 53: 744–749.