METHODS: A retrospective analysis of 164 consecutive patients with urinary retention who underwent HoLEP between January 2000 and August 2004 was performed.RESULTS: The mean patient age was 72.1 years (range, 34 to 95). The mean duration of urinary retention was 2S.9 days (range, 2 to 365). Preoperative transrectal ultrasound measured prostate volume was 107.14 cc (range, 5 to 242). The mean enucleation and morcellation times were 97.S7 minutes (range, 12 to 4SS) and 22.04 minutes (range, 3 to 120), respectively. The mean weight of resected tissue was Sl.9 grams (range, 2.5 to 271 ). Pathologic evaluation of the tissue demonstrated benign prostatic hyperplasia in 154, and adenocarcinoma in 10 (Gleason 3+3 in S patients and 3+4 in 2 patients). The mean duration of post-operative catheterization and hospitalization was 22.4S hours (range, 2 to 240) and 34.54 hours (range, 2 to 336), respectively. Peri-operative complications included: 1 (0.5%) self-limited re-catheterization due to urinary retention which resolved without an additional procedure, 2 (1.0%) clot retention episodes requiring temporary repeat catheterization, and blood transfusion in 3 patients. Postoperative uroflows were recorded for 60 patients at the 6 month follow-up visit, with a mean maximum flow of 24.15 cc/second (range, 4.3 to 54.S). Postoperative AUA symptom scores were recorded for the same 60 patients, with a mean score of 4.0 (range, 0 to 25).CONCLUSIONS: HoLEP is a safe and effective treatment for patients with urinary retention, even in men with very large prostates. All of the patients in this consecutive series were able to void following treatment, and are currently maintained catheter-free. These results, as well as the large amount of prostatic tissue enucleated, suggest that HoLEP may be the ideal treatment for men suffering from urinary retention due to benign prostatic obstruction.

In the Karnell Cancer Center Grand Rounds, we present a patient who underwent radical prostatectomy with bilateral pelvic lymphadenectomy, but had positive margins and subsequently developed local recurrence and then systemic disease. Pathologic and radiologic aspects of his disease are discussed. Therapeutic options at different stages of the disease are examined from the point of view of the urologist, radiation oncologist, and medical oncologist.The surgical portion of the discussion focuses on the selection of initial therapy. Both the selection of surgical candidates and choice of pre-or post-operative therapy in patients can be aided by prognostic tools looking at several variables, including prostate-specific antigen (PSA) level, Gleason score of the tumor, seminal vesicle invasion, extracapsular invasion, and lymph node involvement. Low-risk patients can be treated with monotherapy, such as radical prostatectomy, external beam radiation therapy, prostate brachytherapy, or cryosurgical ablation of the prostate. Higher risk patients may require adjuvant and possibly neoadjuvant therapy in addition.The radiation portion of the discussion focuses on the use of radiation therapy as salvage for relapsing disease.Of particular importance is the point that treating highrisk patients whose PSA levels have started to rise but are less than 1 ng/ml results in a long-term PSA control rate as high as 75%, but that limiting the use of salvage radiation therapy to patients with high PSA levels or biopsy confirmation of local recurrence in the face of a negative bone scan results in biochemical long-term control of less than 40%.In the medical oncology part of the discussion, the major focus is on the use of chemotherapy to treat patients whose disease has become resistant to hormonal therapy. Mitoxantrone plus a corticosteroid has been found to offer significant palliation for such patients. Combination therapy with estramustine plus taxanes, other microtubule inhibitors, or other agents such as topoisomerase II inhibitors, has been found to cause shrinkage of measurable soft tissue disease and diminution of serum PSA levels. The development of effective hormonal and chemotherapeutic drugs for treatment of metastatic disease has led to new interest in adjuvant and neoadjuvant therapy of high-risk patients.

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