Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Abstract

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

The Learning Curves for Laser Application in Urology Procedures: Review of the Literature

“…We also attempted to assess the learning curves of PVP and HoLEP by reviewing the literature. [1][2][3][4][5] I: Photo-Selective Vaporization of the Prostate PVP as one of the methods to treat BPH has some advantages, including tissue ablation by rapid vaporization as well as rapidly hemostatic characteristics resulting in minimal intraoperative bleeding and the use of saline as an irrigating fluid resulting in less transurethral resection syndrome compared with conventional transurethral resection of the prostate (TURP). 6,7 These advantages have made PVP an alternative to traditional TUR of the prostate even in a large prostate gland.…”

“…With its common use of small-diameter endoscopic devices, urology has been extremely and positively influenced by this equipment. 1,2 It is very important to know that surgical experiences would affect the perioperative outcomes of the surgery. The problem with this technology, however, is the time, when a surgeon reaches the acceptable level of safety and efficacy.…”

A novel mouse model simulating transurethral laser vaporization prostatectomy

“…2 Prostatectomy has been performed for more than 100 years and mainly includes open prostatectomy, transurethral prostatectomy, transurethral laser prostatectomy (TULP), and other minimally invasive surgeries. 3 With the improvement in surgical equipment and the development of minimally invasive surgery, transurethral laser vaporization prostatectomy has been widely used in the clinic. However, there is still controversy about the mechanism of prostatic urethra repair after TULP.…”

“Fenestration and Tunnel Method” a Modification for the Holmium Laser Transurethral Prostatectomy of Large-Volume Prostates >80 ml: A Retrospective Study Based on 1-Year Follow-Up

“…Benign prostatic hyperplasia (BPH) is one of the most common medical problems in aging people, occurring in about 80% of men by the 8th decade of their life ( Abedi et al, 2020 ; Jeon et al, 2019 ). Holmium laser enucleation of the prostate (HoLEP) has recently become the recommended treatment for prostate in all sizes in BPH surgery ( Abedi et al, 2020 ; Large & Krambeck, 2018 ; Robert et al, 2018 ; Vincent & Gilling, 2015 ). Nowadays, HoLEP is recommended by the current guidelines of the European Association of Urology (EAU) in men with substantially enlarged prostates (>80 ml) as the first choice ( Zhang et al, 2020 ).…”