HoLEP Outcomes Are Durable

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Laser procedure for BPH called a “true alternative” to open surgery.

BERLIN—Holmium laser enucleation of the prostate (HoLEP) for BPH provides long-term outcomes comparable to those of open prostatectomy, according to a five-year comparison study.
 
The findings, presented here at the 22nd annual European Association of Urology Congress, focused on 84 men who completed five years of follow-up. They were among 120 men with prostates larger than 100 grams and who were randomly assigned to one of the two procedures—60 to HoLEP and 60 to open prostatectomy. The HoLEP and open prostatectomy groups had mean prostate volumes of 115 and 113 grams, respectively.
 
Early results, which were published in 2002 by Rainer M. Kuntz, MD, and Karin Lehrich, MD, of the Auguste Viktoria Hospital here, showed that the two procedures resulted in a similar and significant improvement in American Urological Association (AUA) symptom scores, peak urinary flow rates, and post-void residual volumes. Dr. Kuntz presented results of the five-year follow-up, which included 45 men in the HoLEP arm and 39 in the open prostatectomy arm.
 
Preoperatively, the men had mean AUA symptom scores of 22 and 21, respectively. Both arms had mean peak flow rates of 4 mL/sec, and their mean residual volumes were 280 and 292 mL, respectively.
 
After five years, both groups had mean AUA symptom scores of 3. The mean peak flow rates were 24 and 24 mL/sec, respectively, and the mean residual volumes were 12 and 5 mL, respectively. The researchers con-cluded that “the long-term improvement of micturition outcome is equally good and lasting” compared with open prostatectomy.
 
Addressing his colleagues, Dr. Kuntz observed that HoLEP “is a true alternative to open prostatectomy” with significantly less perioperative morbidity and blood loss and shorter hospital stays. In addition, late complications are equally uncommon with both procedures.
 
In a separate presentation, investigators at Tauranga General Hospital in Tauranga, New Zealand, also presented data showing that HoLEP provides durable outcomes in urodynamically obstructed patients. Their study focused on 38 men. After a mean 5.7 years post-procedure, the men had a mean International Prostate Symptom Score of 8.5 and a maximum urinary flow rate of 18.8 mL/sec. Thirty-one patients (82%) were either satisfied or extremely satisfied.

In addition, researchers in the United Kingdom presented data showing that HoLEP is safe and efficacious at all prostate volumes. They studied 216 patients treated with the procedure, dividing them into three groups based on the weight of tissue enucleated (group 1, less than 40 g [94 men]; group 2, 40-80 g [71 men]; group 3, more than 80 g [51 men]).

The mean weight of the enucleated tissue was 22, 59, and 119 g,  respectively. The efficacy of enucleation increased along with the weight of the enucleated tissue (0.5 g/min in group 1 compared with 1.3 g/min in group 3). Men in group 3 had a significantly longer hospital day compared with men in group 1 (2 vs. 1 day). Only two patients who were in urinary retention preoperatively failed to void after the procedure: one in group 1, one in group 2, and none in group 3.

Among patients not in urinary retention preoperatively, the three groups had similar significant improvements in IPSS, quality of life, maximum urinary flow rates, and post-void residual volume at three months. In the patient with the largest prostate in this series, the surgeons removed 235 g of prostate tissue without major complications.

“Holmium laser enucleation of the prostate seems to be a safe and efficacious procedure for prostates of all volumes,” said investigator Tevita Aho, MD, of Addenbrooke's Hospital in Cambridge, adding, “We believe that HoLEP has no upper prostate volume limit.”
 
Although hospital stays increased slightly among the men in group 3 with the largest prostates, many of those men had huge glands and would have been unsuitable for other endoscopic interventions, Dr. Aho said.
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