Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

Abstract

<b><i>Introduction:</i></b> The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications. <b><i>Methods:</i></b> All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed<sup>®</sup>, Scopus<sup>®</sup>, and Web of Science™ databases from January 1, 1998, to June 1, 2020. <b><i>Results:</i></b> Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0–7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%). <b><i>Conclusions:</i></b> HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1–2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique.

Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis

“…PPUI, a common complication in BPH patients who have received TURP or HoLEP and other laser techniques, is usually caused by damage to the proximal part of the rhabdosphincter, distal to the seminal colliculus 9 , 42 . The incidence rate of PPUI in BPH is 1.8–8.8%, the prevalence rate of transient PPUI, which resolves within 1 year is 7%, and the incidence rate of permanent PPUI is 1.3% 13 , 43 . Several studies have reported the prevalence of PPUI in patients with PCa as 4–30%, according to the definition of PPUI used 44 .…”

Holmium laser enucleation of the prostate (HoLEP) is safe and effective in patients with high comorbidity burden

“…We could speculate that laser setting is likely to play a key role in addressing functional outcomes but other elements are probably more critical. In particular, maintaining an anatomical dissection plane, reducing traction to the sphincter during the enucleation and avoiding capsular perforation are together crucial to allow a fast recover from irritative symptoms following HoLEP ( 30 ). Recent evidence also demonstrated the importance of the apical release in the very beginning of the procedure to maximize functional success ( 18 , 31 , 32 ).…”

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review (Part 6): Correlation of PD-L1 Expression with the Status of Mismatch Repair System, BRCA, PTEN, and Other Genes

“…Systematic literature reviews and metanalyses (SLRs) conducted according to the PRISMA guidelines (including an evidence-based minimum set of items for reporting) ( , accessed on 8 May 2021) are increasingly important in health care, keeping medical doctors up to date, and also representing the background for developing clinical guidelines/trials, as well as the justification for financial supports of research projects. Usually conducted by multidisciplinary teams, SLRs performed according to these guidelines could be applicable in various topics/contexts, improving the research quality not only of pure meta-analyses but also of SLRs applied to case report/series [ 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , …”