Critical analysis of a multicentric experience with holmium laser enucleation of the prostate for benign prostatic hyperplasia: outcomes and complications of 10 years of routine clinical practice

Abstract

Objective To assess the perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in real‐life practice and investigate the factors influencing the safety and effectiveness of the technique. Patients and Methods Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP over 10 years of routine practice in three hospitals. Analysed variables included: preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. prostate‐specific antigen (PSA) level, maximum urinary flow rate [Qmax], and International Prostate Symptom Score [IPSS]), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early postoperative outcomes (change in blood parameters, catheterisation time, and hospital stay), and 12‐month follow‐up outcomes (change in IPSS, PSA level, and Qmax). Results The analysis included 963 patients, aged 48–91 years, with a mean (range) prostate size of 91 (35–247) mL. The mean (sd) operation time was 77 (29) min, and the hospital stay and catheterisation time were 4 (2) and 1.3 (2) days, respectively. In all, 56 patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or transurethral resection of the prostate due to intraoperative complications. Patients had a significant decrease in haemoglobin and haematocrit, but no differences were seen between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and <100 mL. The concomitant removal of bladder calculi and having a prostate ≥100 mL resulted in a longer operation time, but did not influence the safety and effectiveness outcomes. Conclusions HoLEP is suitable for real‐life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, bladder lithiasis or a prostate ≥100 mL.

Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience

“…The one-year median PSA decreased by 70.4% compared to the baseline value and confirmed the complete removal of the adenoma. These results are in line with the current large series of ThuVEP and HoLEP [25,26].…”

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

“…Second, we corroborate that HoLEP can safely be performed and offers excellent early functional outcome, regardless of prostate size. 8,22,23 Specifically, while procedural characteristics such as time of enucleation and morcellation increased proportionally among the volume strata, blood transfusion and complication rates did not differ significantly. The blood transfusion rate of 3.1% observed in our fourth volume quartile (106-280 mL) is greater than in some single-surgeon HoLEP series, 22,23 but comparable to recent multicenter series.…”

“…Despite level 1 evidence of a superior efficacy, 5 HoLEP dissemination has been limited-as witnessed by a small number of single-center reports. [6][7][8] Against this backdrop, we aimed to provide a meticulous report on our series of more than 1800 cases of HoLEP, including 184 octogenarians, over 400 patients with prostates over 100 mL, and over 600 patients with a history of AT. Several of our findings merit further discussion.…”

“…For example, Romero-Otero and colleagues in their HoLEP series observed a blood transfusion rate of 5.8% (n = 362) in prostates ‡100 mL. 8 To provide further perspective, it ought to be noted that our frequency of adverse events lies well below those published from large TURP series, with transfusion and surgical revision rates of 9.5% and 8.2% among prostates >60 mL. 2 The fact that DHb did increase significantly with prostate size, but not transfusion rate, corresponds with the clinical impression that prolonged postoperative hematuria occurs in larger prostates but is managable conservatively with prolonged irrigation.…”

“…2,5 Nevertheless, despite level one evidence of superior efficacy, safety, and cost effectiveness of HoLEP over TURP and open adenomectomy, a wider acceptance of HoLEP has been hampered, possibly due to initial costs or an allegedly unfavorable learning curve. 6 As such, only few reports exist on single-center experiences in performing HoLEP, [6][7][8] aside the evidence from a number of randomized controlled trials. 9 However, the latter studies often include a patient selection that might not be representative of a real-world experience, yet, at an ever-increasing proportion of elderly patients in western populations, a greater number of men are undergoing HoLEP with larger prostate size, at a greater age.…”