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Holmium laser enucleation of the prostate in Jehovah’s Witness patients

  • Ashraf Selim
  • Charles U. NottinghamEmail author
  • Nadya E. York
  • Casey A. Dauw
  • Michael S. Borofsky
  • Ronald S. Boris
  • James E. Lingeman
Urology - Original Paper

Abstract

Purpose

To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion.

Materials and methods

Between August 2008 and March 2019, nine Jehovah’s Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate.

Results

The average age was 71.4 years (range 53–87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6 ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141 g (range 18–344 g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively.

Conclusion

HoLEP is a reasonable option for Jehovah’s Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.

Keywords

Holmium laser enucleation of the prostate Benign prostate hyperplasia Jehovah’s Witness Lower urinary tract symptoms 

Abbreviations

BPH

Benign prostate hyperplasia

EPO

Erythropoeitin

HoLEP

Holmium laser enucleation of the prostate

LUTS

Lower urinary tract symptoms

TURP

Transurethral resection of the prostate

Notes

Author contributions

AS: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. CUN: data collection or management, data analysis, and manuscript writing/editing. NEY: data collection or management, and data analysis. CAD: data collection or management, and data analysis. MSB: data collection or management, and data analysis. RSB: protocol/project development, data collection or management, and data analysis. JEL: protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The following disclosures are listed as follows. JE Lingeman is a consultant for Boston Scientific and Lumenis. CA Dauw is a consultant for Boston Scientific. MS Borofsky is a consultant for Boston Scientific and Auris Health. All other authors declare no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval was approved at our institution (number 101000224).

Informed consent

Informed consent was not obtained on patients given the retrospective nature of the study. The study was approved by the IRB at our institution (number 101000224).

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity College LondonLondonUK
  2. 2.Department of UrologyIndiana University School of MedicineIndianapolisUSA
  3. 3.UrologyAuckland City HospitalAucklandNew Zealand
  4. 4.Department of UrologyUniversity of Michigan Health SystemsAnn ArborUSA
  5. 5.Department of UrologyUniversity of MinnesotaMinneapolisUSA

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