To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6–8 points) showed significant increase in the OT (74.61, 95%CI = 16.98–327.84, P < 0.001), hemochrome reduction (416.50, 95%CI = 35.48–4889.88, P < 0.001), hospital stay (1.80, 95%CI = 1.35–2.41, P < 0.001), and bladder irrigation duration (4.04, 95%CI = 1.35–12.10, P = 0.013) compared with the low BPHSS group (0–2 points). In the prospective study, there also existed significant differences between the three scoring grades (P < 0.01) in OT, hemochrome decrease, and the hospital stay. The BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. Further studies are needed to validate this scoring system in BPH patients in multiple centers.
Benign prostatic hyperplasia Holmium laser enucleation of the prostate Perioperative outcomes Scoring system
benign prostatic hyperplasia
BPH surgical scoring
holmium laser enucleation of the prostate
intravesical prostatic protrusion
transurethral enucleation of the prostate
transurethral resection of the prostate
receiver operating characteristic
European Association of Urology
area under the curve
prostatic arterial embolization
5-α reductase inhibitors
lower urinary tract symptoms
This is a preview of subscription content, log in to check access.
This research was supported by Shanghai Pudong new area health and family planning project (NO. PW2013D-3), key disciplines group construction project of Pudong Health Bureau of Shanghai (PWZxq2014-11), Program for Outstanding Medical Academic Leader, and Speciality Construction Project of Pudong Health, and Family Commission of Shanghai (NO. PWZz2013-16).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval and consent to participate: ethical approval of the patients were obtained in our study from Shanghai 9th People’s Hospital Ethics Committee.
Written informed consent was obtained from each patient.
Oelke M et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140CrossRefPubMedGoogle Scholar
Kahokehr A, Gilling PJ (2014) Enucleation techniques for benign prostate obstruction: which one and why? Curr Opin Urol 24(1):49–55CrossRefPubMedGoogle Scholar
Rieken M, Bachmann A (2014) Laser treatment of benign prostate enlargement--which laser for which prostate? Nat Rev Urol 11(3):142–152CrossRefPubMedGoogle Scholar
Grundy SM et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17):2735–2752CrossRefPubMedGoogle Scholar
Chen YB et al (2013) A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. J Urol 189(1):217–222CrossRefPubMedGoogle Scholar
van Rij S, Gilling PJ (2012) In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new 'gold standard'. Curr Urol Rep 13(6):427–432CrossRefPubMedGoogle Scholar
Geavlete B et al (2013) Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases—a medium term, prospective, randomized comparison. BJU Int 111(5):793–803CrossRefPubMedGoogle Scholar
Elzayat EA, Habib EI, Elhilali MM (2005) Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology 66(5 Suppl):108–113CrossRefPubMedGoogle Scholar
Busetto GM et al (2015) Short-term pretreatment with a dual 5α-reductase inhibitor before bipolar transurethral resection of the prostate (B-TURP): evaluation of prostate vascularity and decreased surgical blood loss in large prostates. BJU Int 116(1):117–123CrossRefPubMedGoogle Scholar
Netsch C et al (2012) Thulium:YAG vapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2-microm lasers. Asian J Androl 14(2):325–329CrossRefPubMedPubMedCentralGoogle Scholar
Lee DJ et al (2016) Laser vaporization of the prostate with the 180-W XPS-greenlight laser in patients with ongoing platelet aggregation inhibition and oral anticoagulation. Urology 91:167–173CrossRefPubMedGoogle Scholar
Gilling P, Anderson P, Tan A (2017) Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol 197(6):1565–1572Google Scholar
Keehn A et al (2017) UroLift in place of fiducial markers for patients with benign prostatic hyperplasia undergoing external beam radiation therapy. Urology 104:230–234CrossRefPubMedGoogle Scholar
Jeong CW et al (2010) Minimally invasive management of postoperative bleeding after radical prostatectomy: transarterial embolization. J Endourol 24(9):1529–1533CrossRefPubMedGoogle Scholar
Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166CrossRefPubMedGoogle Scholar
Monn MF et al (2015) Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate. Urology 86(2):338–342CrossRefPubMedGoogle Scholar
Hirayama K et al (2015) Evaluation of intravesical prostatic protrusion as a predictor of dutasteride-resistant lower urinary tract symptoms/benign prostatic enlargement with a high likelihood of surgical intervention. Urology 86(3):565–569CrossRefPubMedGoogle Scholar
Lee JY et al (2012) Single-port transvesical enucleation of the prostate for benign prostatic hyperplasia with severe intravesical prostatic protrusion. World J Urol 30(4):511–517CrossRefPubMedGoogle Scholar
Marks LS, Roehrborn CG, Andriole GL (2006) Prevention of benign prostatic hyperplasia disease. J Urol 176(4 Pt 1):1299–1306CrossRefPubMedGoogle Scholar
Roehrborn CG et al (2001) Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urology 58(2):210–216CrossRefPubMedGoogle Scholar
Roehrborn CG et al (1999) Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology 53(3):581–589CrossRefPubMedGoogle Scholar
Ma D et al (2014) Correlation between molecular biomarkers and risk factors for the clinical progression of benign prostatic hyperplasia using tissue microarray immunostaining. Chin Med J 127(23):4031–4035PubMedGoogle Scholar
Choo MS et al (2014) Transurethral surgical anatomy of the arterial bleeder in the enucleated capsular plane of enlarged prostates during holmium laser enucleation of the prostate. Int Neurourol J 18(3):138–144CrossRefPubMedPubMedCentralGoogle Scholar