Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results From a 2-Center Prospective Randomized Trial in Patients With Obstructive Benign Prostatic Hyperplasia

Montorsi, Francesco; Naspro, Richard; Salonia, Andrea; Suardi, Nazareno; Briganti, Alberto; Zanoni, Matteo; Valenti, Sergio; Vavassori, Ivano; Rigatti, Patrìzio

doi:10.1016/j.juro.2008.03.143

Cited by 333 publications

(183 citation statements)

References 17 publications

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“…Randomized control studies have shown that symptom improvement attained after HoLEP is comparable to that obtained following TURP, with favorable results including removed tissue weight, duration of catheterization, hospital stay, need for blood transfusions, and the absence of TURP syndrome (4,5,(17)(18)(19). Similar treatment outcomes have been demonstrated when HoLEP was compared to open prostatectomy for the treatment of large prostates.…”

Section: Discussionmentioning

confidence: 69%

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Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Jeong

Cho

et al. 2012

Int. braz j urol.

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Section: Discussionmentioning

confidence: 69%

“…Compared to TURP or open prostatectomy, HoLEP has similar clinical outcome, lower postoperative complication rate and requires shorter hospital stay (4)(5)(6)(7)(8). In addition, HoLEP appears to be a true endourological alternative to open prostatectomy, because it can effectively treat a very large prostate (9,10).…”

Section: Original Article Introductionmentioning

confidence: 99%

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Jeong

Cho

et al. 2012

Int. braz j urol.

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“…In these settings HoLEP would have a clear advantage and as shown in the present series at no added risk. [ 12 ] n.r n.r -Gilling et al . [ 14 ] 116.14 n.r -Present study ( [ 5 ] n.r n.r -Montorsi et al .…”

Section: Discussionmentioning

confidence: 99%

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

2012

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E 8 4 5What ' s known on the subject? and What does the study add? The major advantage of holmium laser enucleation of the prostate (HoLEP) depends on the ability to use the native anatomical plane between the prostate adenoma and surgical capsule, peeling each prostatic lobe from the capsule. HoLEP is associated with less catheterisation time, hospital stay and blood loss than transurethral resection of the prostate (TURP) or open prostatectomy. Urodynamic relief of obstruction has been reported to be better with HoLEP than TURP. However, surgical treatment of recurrent prostatic obstruction after previous transurethral surgery for symptomatic benign prostatic hyperplasia is more challenging because of loss of anatomical landmarks resulting in either incomplete removal or incontinence.HoLEP for recurrent symptoms due to residual or re-growing prostatic adenoma seems to be as safe, feasible and effi cient as HoLEP for de novo cases. The surgical plane between the adenoma and the surgical capsule was still accessible resulting in a durable long-term outcome with minimal side-effects. Previous transurethral prostatic surgery is not a contraindication for HoLEP. OBJECTIVE• To assess the technical feasibility, functional outcome and morbidity of holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia (BPH) in patients with previous transurethral prostate surgery. ' Redo ' surgery for recurrent or residual BPH poses a technical challenge with uncertain outcome as a result of disturbed anatomical landmarks with no clear surgical limits. PATIENTS AND METHODS• We retrospectively reviewed 1054 patients who underwent HoLEP for symptomatic BPH.• Patients were stratifi ed into two groups, group-I with no previous prostate surgery or primary-HoLEP (978 patients) and group-II with history of previous prostate surgery or secondary-HoLEP (76).• All patients ' variables as well as follow-up data were assessed and compared. RESULTS• There were no signifi cant differences in baseline criteria between the two groups ( P > 0.05).• In group-II, HoLEP was done after a median (range) of 66 (13 -121) months from previous prostate surgeries, including transurethral resection of the prostate (48 patients), HoLEP (eight), transurethral incision of the prostate (nine), photoselective vaporization of the prostate (four) and other procedures (seven).• In both groups, routine HoLEP technique was adopted, the plane of enucleation could be identifi ed without extra diffi culty. However, more energy per gram of prostate tissue was needed in group-II ( P < 0.05).• Operative auxiliary procedures were indicated in 1.9% of group-I, and 1.3% of group-II ( P > 0.05). There were no operative complications or blood transfusion in group-II. The mean hospital stay and catheter time was similar in both groups. Early and late postoperative complications were not statistically different ( P > 0.05).• At 1 month the mean maximum urinary fl ow rate (Q max ) was 22.3 and 18.8 mL/s, postvoid residual urine volume (PVR) was 4...

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“…Several randomized controlled trials have clarified that HoLEP is superior to TURP [10][11][12][13] and open prostatectomy. [14][15][16] Other reports have documented that HoLEP is as durable as open prostatectomy at more than 5-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

The relationship between the reproducibility of holmium laser enucleation of the prostate and prostate size over the learning curve

Haraguchi

Takenaka

Yamazaki

et al. 2009

Prostate Cancer Prostatic Dis

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The purpose of this study was to analyze the relationship between the reproducibility of holmium laser enucleation of the prostate (HoLEP) and prostate size over the learning curve. We compared the outcome among three institutions in three subgroups on the basis of the weight of tissue retrieved. There were no significant differences in operating time, efficiency of the procedure, decrease in hemoglobin level and postoperative urinary incontinence among three institutions, only in patients with prostates X20 g-o40 g retrieved. Our data indicate that HoLEP is more reproducible in patients with a moderate-sized prostate over the learning curve.

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Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results From a 2-Center Prospective Randomized Trial in Patients With Obstructive Benign Prostatic Hyperplasia

Abstract: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Cited by 333 publications

References 17 publications

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

The relationship between the reproducibility of holmium laser enucleation of the prostate and prostate size over the learning curve

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