Transurethral Holmium Laser Enucleation of the Prostate Versus Transurethral Electrocautery Resection of the Prostate: A Randomized Prospective Trial in 200 Patients

Kuntz, Rainer M.; Ahyai, Sascha; Lehrich, Karin; Fayad, Amr

doi:10.1097/01.ju.0000136218.11998.9e

Cited by 316 publications

(222 citation statements)

References 18 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: Discussionsupporting

confidence: 52%

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: Discussionsupporting

confidence: 52%

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 this study, temporary urinary retention reported in three patients (5.8%) was resolved by 24-h catheterization. Recatheterization with the HoLEP procedure varies from 0 to 7.7% 18,19 and with the 80 W KTP laser from 1 4 to 15.4%. 20 …”

Section: Discussionmentioning

confidence: 99%

Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

Leonardi¹

2009

Prostate Cancer Prostatic Dis

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This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a power of 100 W in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Patients were selected for surgery on the basis of maximum urinary flow rate (Qmax) p15 ml/s or transvesically measured post-voiding residual volume (PVR) 4100 ml in conjunction with an International Prostate Symptom Score (IPSS) 47. Laser therapy was conducted under spinal anaesthesia. Qmax, IPSS, prostate volume, PVR, IPSS-Quality of Life (QoL) questionnaire and ejaculatory function were measured at baseline and at 1, 3, 6 and 12 months post-laser therapy. A total of 52 consecutive patients aged 52-65 years with mean (s.d.) prostate volume of 45.14 (9.15) g were treated. All patients were able to leave the hospital at a mean (s.d.) of 5 (2) h after the procedure. Mean (s.d.) follow-up was 100 (75.49) days. A significant reduction in IPPS was reported at 1 month (Po0.0001) and this was maintained through to 6 months. Significant durable improvements in Qmax, PVR and IPSS-QoL score were also reported for all patients (Po0.0001). No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. This early experience in a pilot study with the 980 nm diode laser seems promising in the short-term and long-term outcome is being monitored.

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“…The equipment used was: an 100-W holmium: YAG (yttrium aluminium garnet) laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA); a 550-nm end-fi ring fi bre (SlimLineTM 550, Lumenis Inc.); a modifi ed continuous-fl ow 26-F resectoscope with a distal bridge; a 6-F catheter through the proximal bridge to stabilise the laser fi bre; continuous saline irrigation; a rigid indirect nephroscope with a 5-mm working channel; a tissue morcellator (Lumenis Inc.); and a video system. In group-I, HoLEP was performed as described previously [ 5,10 ] . Briefl y, a plane was created between the adenoma and the surgical capsule early after the fi rst incision of the gland from the bladder neck to the level of the verumontanum.…”

Section: Surgical Techniquementioning

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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Transurethral Holmium Laser Enucleation of the Prostate Versus Transurethral Electrocautery Resection of the Prostate: A Randomized Prospective Trial in 200 Patients

Abstract: HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.

Cited by 316 publications

References 18 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

Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

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

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