HoLEP Safely Provides Durable BPH Outcomes

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Holmium laser enucleation of the prostate (HoLEP) is safe and effective for treating benign prostatic hyperplasia (BPH), a study shows.

After reviewing data from 1,065 HoLEP procedures performed from June 1998 to March 2009 at Methodist Hospital Institute for Kidney Stone Disease in Indianapolis, investigators concluded that these operations have durable long-term results, the complication rate is low, and incontinence and the need for ancillary procedures are rare, according to a report in The Journal of Urology (2010;183:1105-1109).

Based on their data, the researchers said they “recommend HoLEP for symptomatic BPH in a gland of any size.”

The researchers, led by James E. Lingeman, MD, examined short-term, intermediate-term, and long-term results (0-6 months, 6-12 months, and greater than 12 months and up to five years after surgery, respectively), as well as more than five years postoperatively.

The patients had a mean age of 75 years (range 40-95 years) at the time of surgery. Ninety-seven patients (9.1%) had prior BPH procedures. Patients had a mean transrectal ultrasound prostate volume of 99.3 grams (range 9-391 grams). Their mean preoperative American Urological Association (AUA) symptom score was 20.3 (range 1-35), and maximum urinary flow rate was 8.4 cc/sec (range 1.1-39.3 cc/sec). Of the 1,065 patients, 411 (38.7%) had urinary retention preoperatively. The mean follow-up was 287 days (range 6-3,571 days).

Eighty-three patients (7.8%) had more than five years of follow-up, with a mean observation period of seven years.

At the most recent follow-up, the mean AUA symptom score was 5.3 and the mean maximum urinary flow rate was 22.7 cc/sec. The researchers identified urinary retention in only three patients (0.3%).

At the short-, intermediate-, long-term follow-up and greater than five-year follow-up, the rate of urethral stricture requiring office dilation was 0.9%, 1.3%, 1.3%, and 0%, respectively. The rate of bladder neck contracture was 0%, 0.8%, 1.3%, and 6%, respectively. The rate of significant stress incontinence was 12.5%, 3.4%, 1.8%, and 4.8% of patients who completed incontinence questionnaires. The researchers identified significant urge incontinence in 11.5%, 3.1%, 1.5%, and 2.2%.

“This series of more than 1,000 HoLEP procedures at a single institution provides substantial supporting evidence for its safety and efficacy for BPH,” Dr. Lingeman's team concluded. “In our study, 99.7% of patients spontaneously urinated postoperatively, although more than a third presented in urinary retention.”

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