HoLEP for Large Prostates Offers Good Outcomes

BANFF, ALBERTA—Holmium-laser enucleation of the prostate (HoLEP) combined with mechanical morcellation is a safe and effective treatment for benign prostatic hyperplasia (BPH) involving glands weighing 200 grams or more, a study has confirmed.

The study examined 58 cases in which HoLEP was performed on prostates weighing at least 200 grams (mean 218 grams). The mean PSA level decreased from 19.9 ng/mL before surgery to 0.85 ng/mL six months after surgery. The mean preoperative American Urological Association Symptom Score decreased from 18.9 before surgery to 3.85 at 12 months. Furthermore, mean post-void residual volume decreased from 237.6 cc preoperatively 34.9 cc at 12 months. The procedure was associated with a 3.4% complication rate.

The researchers believe the combination of HoLEP enucleation and morcellation is one of the best surgical treatments for BPH. “It offers at least an equivalent if not superior result to transurethral prostatectomy and open prostatectomy in terms of length of catheterization, length of stay, lower rate of transfusion and has a very low re-intervention rate,” said primary investigator Naeem Bhojani, MD, who is presenting the results at the Canadian Urological Association's 2012 annual meeting. “Using HoLEP also allows for the acquisition of a pathological tissue specimen. Finally and most importantly, these results are durable, reproducible and can be applied to any prostate gland size.”

Dr. Bhojani agrees with other clinicians that HoLEP's complexity limits its use to only a handful of centers. The learning curve is 15 to 20 cases when taught by a mentor and approximately double that without one, he said.

An average of 213.4 grams of tissue was removed. Enucleation took an average of 86.7 minutes and morcellation averaged 49.3 minutes.

The mean length of post-operative catheterization was 19.9 hours (range 8-96 hours). The average post-operative hemoglobin was 11.5 g/dL. All 58 cases experienced spontaneous voiding after catheter removal.

Two post-operative complications occurred and both required transfusion. One patient was treated the same day for bleeding, and the other was brought back 48 hours later for completion of morcellation.

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