BJU Int. 2008; published online ahead of print
The efficacy of holmium laser enucleation of the prostate (HoLEP) in the treatment of symptomatic BPH increases with prostate size, according to researchers in India.
Hemendra N. Shah, MD, and colleagues at the R.G. Stone Urological Research Institute in Mumbai, reviewed the records of 354 BPH patients treated with HoLEP. The prostate weighed less than 60 g in 235 men (group 1), 60-100 g in 77 men (group 2), and more than 100 g in 42 men (group 3). The mean prostate size for the three groups was 38.1, 76.4, and 133.5 g, respectively. The mean weight of the resected prostate was 18.47, 40.8, and 82.76 g. The mean procedure efficacy increased from 0.36 g/min in group 1 to 0.49 min in group 2 and 0.58 g/min in group 3, a significant difference between groups.
Overall, at one-year follow-up, HoLEP resulted in a 75% reduction in American Urological Association symptom score (from 19.35 to 4.77), a 225% increase in peak urinary flow rate (from 7.86 to 17.70 mL/sec), and an 86% decrease in postvoid residual volume (from 142.7 to 19.5 mL). The three groups were similar with respect to perioperative complications, although the men in group 3 had a higher incidence of superficial bladder mucosal injury and stenotic complications.
“The completeness of resection and the safety profile of HoLEP is unparalleled by any other endoscopic technique,” the authors noted. “The ability of HoLEP to treat every size and configuration of prostate makes it more appealing.”