How obesity affects the benefits of holmium laser enucleation of the prostate for the treatment of male lower urinary tract symptoms

Abstract

Objectives: Holmium laser enucleation of the prostate (HoLEP) can be used regardless of prostate size and offers durable long-term results for patients suffering from lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO), with reduced perioperative morbidity. In most western societies almost half of the population are overweight, and obesity itself is often a risk factor for surgical treatment of patients. We therefore analysed the impact of body mass index (BMI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral centre. Methods: We retrospectively collected data for 877 patients who underwent HoLEP for LUTS/BPO between 2014 and 2018 and divided patients into group 1 (BMI<25), 2 (BMI 25<30), and 3 (BMI⩾30). We analysed perioperative parameters, safety, and short-term functional outcomes. Results: In preoperative patient characteristics we observed a similar LUTS profile throughout our patient cohorts. The highest proportion of ASA score ⩾III was observed in the obese patient cohort. Enucleation time was significantly prolonged in morbidly obese patients and operative speed was significantly slower, without difference in perioperative complications. Functional outcomes were assessed 30 days post-surgery with significant improvement in IPSS, quality of life (QoL) and Qmax for all groups. Conclusion: Although operating on overweight and obese patients takes significantly longer, HoLEP is efficient and offers acceptable perioperative complication rates even in morbidly obese patients (BMI⩾30). Level of evidence: Not applicable.

Impact of obesity on peri-operative and long-term functional outcomes after robotic assisted simple prostatectomy

“…The patient populations in both study cohorts are comparable to those described elsewhere in this setting, comprising severely symptomatic individuals (median IPSS: 25 for non-obese and 20 for obese patients) with severe BOO (median Qmax: 8mL/ second for non-obese and 6 mL/second for obese patients mL/second) and enlarged prostate glands (median prostate volume: 90 ccs for both groups). ASA profile scores did not differ between our patient cohorts, as previously reported in other series [20]. The analysis of post-operative outcomes elicits few comments.…”

“…In this respect, still limited evidence exists. In a large-retrospective cohort, holmium enucleation of the prostate had comparable short-term functional outcomes and complication rates among obese and non-obese individuals [20]. This topic certainly warrants further investigation.…”

“…In terms of length of stay (LOS) this was similar for both groups (median LOS: 3 days) and less when contrasted to the OSP series [24], but considerably longer compared with laser and bipolar energy surgeries [20]. In this regard, LOS might be affected by nonmedical factors based on the healthcare system where treatment is conducted.…”

“…Consequently, these results can be viewed in different ways. This is likely not true for catheterization time as RASP does not provide the same results as endoscopic procedures [20].…”

Efficacy, efficiency, and safety of en-bloc vs. three-lobe enucleation of the prostate: a propensity score-matched analysis

“…With recent introductions of different HoLEP techniques, such as the en-bloc, two-lobe, or "omega" resection [13,14], there are only a limited number of studies focusing on comparing perioperative data and postoperative functional outcomes, and the exact differences or benefits of either technique remain mainly unclear [15,16]. As patients and practitioners alike, have a variety of treatment options to choose from when medical treatment for LUTS/BPO fails or is not feasible [7,17,18], a closer look at the underlying technique, further expanding the benefits of laser enucleation, becomes mandatory. While there certainly is no doubt about the benefits of HoLEP compared to TURP or OP, some technical aspects have still been up for discussion.…”