Holmium Laser Enucleation of the Prostate is Effective in the Treatment of Symptomatic Benign Prostatic Hyperplasia of Any Size Including a Small Prostate

Abstract

PurposeAlthough transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size.Materials and MethodsWe retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, <40 g; group 2, 40-79 g; and group 3, >80 g), and 45 patients were selected for each method.ResultsNo major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume.ConclusionsHoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP.

Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and &#x3e; 80 mL

“…Further, the enucleation rate in the HoLEP group was 0.685, which was higher than that in the TURP group, but statistically significant difference was observed only in > 80-mL PVs. The enucleation rate was 0.68 in the HoLEP group and 0.63 in the TURP group [8]. The findings of enucleated tissue weight have been inconclusive in literature, being reported as high in the OSP group in some studies and high in the HoLEP group in others [17,18,20].…”

“…In a previous study, the enucleated tissue weight was greater in the HoLEP group than in the TURP group [8]. Further, the enucleation rate in the HoLEP group was 0.685, which was higher than that in the TURP group, but statistically significant difference was observed only in > 80-mL PVs.…”

“…They divided patients into 3 groups according to the PVs; group 1 (< 100 mL), group 2 (100-200 mL), and group 3 (> 200 mL). Qmax, IPSS, PVR, and QoL score were not significantly different between the groups [8]. In our study, we also compared HoLEP outcomes for different PVs (Group 1: ≤80 mL, Group 2: > 80 mL).…”

“…Most recent studies have focused on the efficacy of Ho-LEP for different prostate sizes [6,8]. Various studies have compared the efficacies of TURP, OSP, and HoLEP for different PVs [14][15][16].…”

“…HoLEP is a unique method that can be performed independent of the prostate size. Although there are many studies on the use of HoLEP in large prostates [2][3][4]6], studies on it use in small prostates are limited [7,8].…”