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A call for HoLEP: AEEP for mega-prostates (≥ 200 cc)

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Abstract

Purpose

To evaluate the efficiency and efficacy of HoLEP, and methods of tissue retrieval, in patients with prostate volume (PV) ≥ 200 cc (Group 1) and to compare these to patients with PV 80–199 cc (Group 2).

Methods

A database of all cases performed under the care of two surgeons at a tertiary HoLEP centre was reviewed.

Results

157 patients with PV ≥ 200 cc were compared to 157 of the most recent consecutive cases with PV 80–199 cc. Median (IQR) enucleation efficiency was greater in Group 1 [2.8 g/min (2.2–3.5)] than Group 2 [2.1 g/min (1.6–2.5), p < 0.001]. Morcellation efficiency did not differ significantly. Cystotomy was required for tissue retrieval in Group 1 only (5.7%). Decrease in serum haemoglobin (Hb) was greater in Group 1 (19 g/l (30–8) vs 12 (18–3.5), p < 0.001) with a transfusion rate of 4.5% vs 1.3%, respectively (p = 0.104). Length of stay was longer in Group 1 than Group 2 (1 day (1–2) vs 1 (1–1), p < 0.001). There were no significant differences between groups in: time to and success of first trial without catheter, pre- and post-operative IPSS, Qmax and PVR, and 3 month catheter-free and urinary incontinence rates.

Conclusion

HoLEP outcomes are largely PV-independent even when PV is ≥ 200 cc, although length of stay and reduction in Hb are greater in this group. Alternatives to pure morcellation, such as cystotomy and resection of nodules, are more likely to be necessary with PV ≥ 200 cc.

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Availability of data and material

All raw data are kept in a secure fashion electronically on our hospital IT system. Data available from the corresponding author upon reasonable request.

References

  1. Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33(1):69–72. https://doi.org/10.1159/000019535

    Article  CAS  PubMed  Google Scholar 

  2. American Urological Association (2020) Benign prostatic hyperplasia: surgical management of benign prostatic hyperplasia/lower urinary tract symptoms. American Urological Association. https://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline. Accessed 29 Oct 2020.

  3. European Association of Urology (2020) Management of non-neurogenic male LUTS/European Association of Urology. https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/. Accessed 29 Oct 2020.

  4. 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. https://doi.org/10.1089/089277904322959851

    Article  PubMed  Google Scholar 

  5. Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R et al (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70g: 24-month follow-up. Eur Urol 50(3):563–568. https://doi.org/10.1016/j.eururo.2006.04.003

    Article  PubMed  Google Scholar 

  6. Szopinski T, Golabek T, Borówka A, Chlosta P (2014) Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting? Wideochir Inne Tech 9(3):398–403. https://doi.org/10.5114/wiitm.2014.43128

    Article  Google Scholar 

  7. Rodriguez E, Skarecky D, Narula N, Ahlering TE (2008) Prostate volume estimation using the ellipsoid formula consistently underestimates actual gland size. J Urol 179(2):501–503. https://doi.org/10.1016/j.juro.2007.09.083

    Article  PubMed  Google Scholar 

  8. Varma M, Morgan J (2009) The weight of the prostate gland is an excellent surrogate for gland volume. Histopathology 57(1):55. https://doi.org/10.1111/j.1365-2559.2010.03591.x

    Article  Google Scholar 

  9. Aho T, Al-Hayek S, Winterbottom A, Koo B, Warren A (2021) “Case of the month” from Cambridge University, UK: managing intractable bleeding from a 375cc prostate in an anti-coagulated patient. BJU Int 127(1):37–40. https://doi.org/10.1111/bju.15303

    Article  PubMed  Google Scholar 

  10. Gazel E, Kaya E, Yalcin S, Aybal HC, Ayogan TB, Tunc L (2019) Comparison of the efficacy of holmium laser enucleation of the prostate in treating prostate volumes of ≤80 and > 80mL. Urol Int 102:306–310. https://doi.org/10.1159/000496173

    Article  PubMed  Google Scholar 

  11. Shah H et al (2008) Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int 101:1536–1541. https://doi.org/10.1111/j.1464-410X.2007.07434.x

    Article  PubMed  Google Scholar 

  12. Zell MA, Abdul-Muhsin H, Navaratnam A, Cumsky J, Girardo M, Cornella J et al (2020) Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol. https://doi.org/10.1007/s00345-020-03156-5

    Article  PubMed  Google Scholar 

  13. 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. https://doi.org/10.1089/end.2009.0147

    Article  PubMed  Google Scholar 

  14. Jaeger CD, Mitchell CR, Mynderse LA, Krambeck AE (2015) Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention. BJU Int 115:295–299. https://doi.org/10.1111/bju.12674

    Article  CAS  PubMed  Google Scholar 

  15. Petersen MD, Matlaga BR, Kim SC, Kuo RL, Soergel TM, Watkins SL, Lingeman JE (2005) Holmium laser enucleation of the prostate for men with urinary retention. J Urol 174:998–1001. https://doi.org/10.1097/01.ju.0000170230.26743.e4

    Article  Google Scholar 

  16. Elzayat EA, Habib EI, Elhilali MA (2005) Holmium laser enucleation of prostate for patients in urinary retention. Urology 66:789–793. https://doi.org/10.1016/j.urology.2005.04.049

    Article  PubMed  Google Scholar 

  17. Routh JC, Bacon DR, Leibovich BC, Zincke B, Blute ML, Frank I (2008) How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery. BJU Int 102(3):301–304. https://doi.org/10.1111/j.1464-410X.2008.07663.x

    Article  PubMed  Google Scholar 

  18. Aho T, Armitage K, Kaster C (2020) Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes! Andrologia. https://doi.org/10.1111/and.13643

    Article  PubMed  Google Scholar 

  19. Del Zingaro M, Bruno R, Nunzi E, Porena M, Mearini L (2016) First and second transurethral resections in intermediate-high risk bladder cancer: impact of the surgeon’s volume on the recurrence and progression of primary bladder cancer. Minerva Urol Nefrol 68:194–203

    PubMed  Google Scholar 

  20. Kandasami S, Mamoulakis C, El-Nahas A, Averch T, Tuncay O, Rawande-Patil A, Cormio L, de la Rosette J (2014) Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 66:1046–1051. https://doi.org/10.1016/j.eururo.2014.06.054

    Article  PubMed  Google Scholar 

  21. Zhang MW, El Tayeb MM, Borofsky MS, Dauw CA, Wagner CA, Lowry PS, Bird ET, Hudson TC, Lingeman JE (2017) Comparison of perioperative outcomes between holmium laser enucleation of the prostate and robot-assisted simple prostatectomy. J Endourol 31:847–850. https://doi.org/10.1089/end.2017.0095

    Article  PubMed  Google Scholar 

  22. Rucker F, Lehrich K, Bohme A, Zacharias M, Ahyai S, Hansen J (2021) A call for HoLEP: en-bloc vs two-lobe vs three –lobe. World J Urol. https://doi.org/10.1007/s00345-021-03598-5

    Article  PubMed  Google Scholar 

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Funding

No funds, grants, or other support was received by any of the authors.

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Authors and Affiliations

  1. Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK

    Nicholas E. Boxall, Fanourios Georgiades, Saiful Miah, Laurian Dragos, James Armitage & Tevita F. Aho

Authors
  1. Nicholas E. Boxall
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  2. Fanourios Georgiades
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  3. Saiful Miah
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  4. Laurian Dragos
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  5. James Armitage
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  6. Tevita F. Aho
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Contributions

NEB: data analysis and manuscript writing. FG: data analysis and manuscript writing. SM: protocol/project development. LD: data collection. JA: data collection. TFA: project development, data collection and management and manuscript writing.

Corresponding author

Correspondence to Tevita F. Aho.

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Conflict of interest

TF Aho has received speaker, consultancy, and mentorship honoraria from Lumenis Ltd and Boston Scientific Corporation. None of the other authors has any conflict of interest or competing interests.

Ethics approval

Approval to collect and analyse data was given by the Cambridge University Hospitals NHS Foundation Trust Audit department.

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Informed consent was obtained from all individual participants included in the audit.

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Boxall, N.E., Georgiades, F., Miah, S. et al. A call for HoLEP: AEEP for mega-prostates (≥ 200 cc). World J Urol 39, 2347–2353 (2021). https://doi.org/10.1007/s00345-021-03708-3

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  • DOI: https://doi.org/10.1007/s00345-021-03708-3

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