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Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc)

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Abstract

Purpose

Patients presenting with prostate gland sizes greater than 200 cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200 cc.

Materials and methods

Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200 cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200–299 cc and ≥ 300 cc. Univariate analysis using Kruskal–Wallis and Fisher exact test was performed to compare the two groups.

Results

There were 88 patients with a mean preoperative gland size of 255.9 cc (200–770 cc). Mean operative (171 vs 182 min) and enucleation time (77 vs 83 min) were not different between the two subgroups (200–299 cc vs ≥ 300 cc). Enucleation efficiency was greater for glands ≥ 300 cc (2.6 cc/min vs 2.0 cc/min, p = 0.04). Morcellation time was longer in the ≥ 300 cc group (74.5 min vs 46.8 min, p = 0.021). Mean length of stay was 1.8 ± 1.2 days and catheter duration was 2.6 ± 2.7 days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis.

Conclusions

Holmium laser enucleation for prostate glands volume > 200 cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.

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References

  1. Mather M, Jacobsen LA, Pollard KM (2015) Aging in the united states. 2015: Population Reference Bureau.

  2. Filson CP, Wei JT, Hollingsworth JM (2013) Trends in medical management of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 82(6):1386–1393

    Article  Google Scholar 

  3. Elshal AM et al (2013) Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: perioperative outcomes of a contemporary series. Arab J Urol 11(4):362–368

    Article  Google Scholar 

  4. Groves HK et al (2013) The incidence of acute urinary retention secondary to BPH is increasing among California men. Prostate Cancer Prostatic Dis 16(3):260–265

    Article  CAS  Google Scholar 

  5. Humphreys MR et al (2008) Holmium laser enucleation of the prostate: outcomes independent of prostate size? J Urol 180(6):2431–2435 (Discussion 2435)

    Article  Google Scholar 

  6. Jones P et al (2016) Holmium laser enucleation versus simple prostatectomy for treating large prostates: results of a systematic review and meta-analysis. Arab J Urol 14(1):50–58

    Article  Google Scholar 

  7. Krambeck AE, Handa SE, Lingeman JE (2010) Holmium laser enucleation of the prostate for prostates larger than 175 grams. J Endourol 24(3):433–437

    Article  Google Scholar 

  8. Gratzke C et al (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109

    Article  Google Scholar 

  9. HE F et al (2019) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE.

  10. Gilling PJ, Kennett KM, Fraundorfer MR (2000) Holmium laser enucleation of the prostate for glands larger than 100 g: an endourologic alternative to open prostatectomy. J Endourol 14(6):529–531

    Article  CAS  Google Scholar 

  11. Glybochko PV et al (2017) Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks. Urologia 84(3):169–173

    Article  Google Scholar 

  12. Yuh B et al (2008) Robot-assisted Millin’s retropubic prostatectomy: case series. Can J Urol 15(3):4101–4105

    PubMed  Google Scholar 

  13. Kuntz RM, Lehrich K, Ahyai S (2004) Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol 18(2):189–191

    Article  Google Scholar 

  14. Monn MF et al (2015) Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate. Urology 86(2):338–342

    Article  Google Scholar 

  15. El Tayeb MM et al (2016) Wolf piranha Versus lumenis versacut prostate morcellation devices: a prospective randomized trial. J Urol 195(2):413–417

    Article  Google Scholar 

  16. McAdams S et al (2017) Morcellation efficiency in holmium laser enucleation of the prostate: oscillating morcellator outperforms reciprocating morcellator with no apparent learning curve. Urology 106:173–177

    Article  Google Scholar 

  17. Tubaro A, de Nunzio C (2006) The current role of open surgery in BPH. EAU-EBU Update Ser 4(5):191–201

    Article  Google Scholar 

  18. Xing N et al (2012) Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia. Transl Androl Urol 1(1):9–13

    PubMed  PubMed Central  Google Scholar 

  19. Sosnowski R et al (2014) Endoscopic simple prostatectomy. Central Eur J Urol 67(4):377–384

    Google Scholar 

  20. Shah AA, Gahan JC, Sorokin I (2018) Comparison of robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia. Curr Urol Rep 19(9):71

    Article  Google Scholar 

  21. Parsons JK et al (2015) A national, comparative analysis of perioperative outcomes of open and minimally invasive simple prostatectomy. J Endourol 29(8):919–924

    Article  Google Scholar 

  22. Kyei MY et al (2016) Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia. BMC Urol 16:17

    Article  Google Scholar 

  23. Suer E et al (2008) Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience. Urology 72(1):90–94

    Article  Google Scholar 

  24. Rassweiler J et al (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50(5):969–980

    Article  Google Scholar 

  25. Serretta V et al (1990s) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60(4):623–627

    Article  Google Scholar 

  26. Matlaga BR et al (2006) Holmium laser enucleation of the prostate for prostates of %3e125 mL. BJU Int 97(1):81–84

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank and recognize Charles A. and Anna Mae Miller for their philanthropic support and generous donation that allowed us to complete this work.

Funding

None.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Michael A. Zell, Haidar Abdul-Muhsin, Anojan Navaratnam, Jameson Cumsky, Joseph Cornella, Amihay Nevo, Scott Cheney & Mitchell R. Humphreys

  2. Department of Biostatistics, Mayo Clinic in Arizona, 5777 E Mlvd, Phoenix, AZ, 85054, USA

    Marlene Girardo

Authors
  1. Michael A. Zell
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  2. Haidar Abdul-Muhsin
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  3. Anojan Navaratnam
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  4. Jameson Cumsky
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  5. Marlene Girardo
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  6. Joseph Cornella
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  7. Amihay Nevo
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  8. Scott Cheney
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  9. Mitchell R. Humphreys
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Contributions

MAZ: manuscript writing/project development; HAM: manuscript writing/editing; AN: manuscript writing/editing; JC: data collection and management; MG: data analysis; JC: data collection and management; AN: manuscript writing/editing; SC: manuscript writing/editing; MRH: manuscript writing/editing.

Corresponding author

Correspondence to Haidar Abdul-Muhsin.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of Mayo Clinic IRB. Our IRB reviewed and approved the retrospective collection of these data. This study does not involve any animal subjects.

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Zell, M.A., Abdul-Muhsin, H., Navaratnam, A. et al. Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol 39, 129–134 (2021). https://doi.org/10.1007/s00345-020-03156-5

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  • DOI: https://doi.org/10.1007/s00345-020-03156-5

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