Abstract
Holmium laser enucleation of the prostate (HoLEP) is a trans-urethral surgical technique with two decodes of increasing evidence in relation to superior efficacy and safety. During this time the technique has benefited from advances in energy technologies, improved availability of these energy sources and evolution of the surgical technique.
In the management of the large obstructive prostate, enucleation provides the benefits of endoscopic approaches while maintaining the anatomical considerations of open surgery. HoLEP utilizes the defined tissue plane between the expanding transition zone adenoma in benign prostatic hyperplasia (BPH) and the peripheral zone. The utilization of the anatomical plane results in the removal of adenoma volume comparable to open/Millin’s prostatectomy and facilitates favorable haemostasis. Laser enucleation is undertaken with saline irrigation and avoids dissection into prostatic venous channels resulting in negligible risk of post-resection absorption syndrome. The technique is well suited for the surgical management of prostates greater than 100 cc where the risks associated with prolonged resection preclude other techniques.
HoLEP offers a safe, efficient and efficacious treatment for BPH related LUTS when compared to other standard surgical therapies. These benefits have been consistently demonstrated in randomized controlled trials comparing HoLEP to TURP and open prostatectomy. Limited studies have been favourable for HoLEP compared to alternative laser treatments for BPH in regards to feasibility and durability with equivocal efficacy. The result has been the emergence of laser enucleation of the prostate as the new gold standard for treating the symptomatic large prostate.
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Catterwell, R., Popert, R., Challacombe, B. (2018). Surgical Treatment: Enucleation of the Prostate. In: Kasivisvanathan, V., Challacombe, B. (eds) The Big Prostate. Springer, Cham. https://doi.org/10.1007/978-3-319-64704-3_7
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DOI: https://doi.org/10.1007/978-3-319-64704-3_7
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