Holmium laser enucleation of the prostate: A truly size-independent method?
BPH
LUTS
benign prostatic enlargement
holmium laser enucleation of the prostate
medical treatment
prostate size
Journal
Lower urinary tract symptoms
ISSN: 1757-5672
Titre abrégé: Low Urin Tract Symptoms
Pays: Australia
ID NLM: 101506777
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
13
06
2021
received:
13
04
2021
accepted:
07
07
2021
pubmed:
30
7
2021
medline:
5
1
2022
entrez:
29
7
2021
Statut:
ppublish
Résumé
To evaluate the impact of prostate size on functional outcomes and perioperative morbidity, we analyzed patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms (LUTS). As LUTS secondary to benign prostatic obstruction (BPO) are a chronic progressive disease, prevalence and prostate size increase with age. HoLEP is a size-independent method for surgical treatment of LUTS/BPO and can be offered in medication-refractory patients with durable long-term results and reduced perioperative morbidity. We retrospectively collected data of 852 patients who underwent HoLEP for LUTS secondary to BPO between 2014-2018. Patients were divided into group 1 (≤60 cc), group 2 (>60 < 120 cc), group 3 (≥120 cc). Perioperative parameters, safety and short-term functional outcomes were assessed and analyzed. Patients in group 3 were significantly older and showed a significantly higher median prostate-specific antigen level. Perioperative parameters, such as enucleation time and morcellation time significantly differed in favor of smaller prostate sizes, while enucleation and morcellation speed showed favorable results for larger prostate sizes. Larger prostates ≥120 cc showed a significantly higher postoperative drop in hemoglobin. However, patients did not differ in postoperative functional outcomes or Clavien-Dindo grade ≥II complications (4.8% of all patients [41/852]). There was no difference in perioperative complications between all groups (P = 0.760). While larger prostates take significantly longer to operate on, postoperative functional outcomes show no difference between all sizes. In conclusion, HoLEP is a size-independent and effective method for surgical treatment of LUTS/BPO in prostates ≥30 cc.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
17-26Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021 The Authors. LUTS: Lower Urinary Tract Symptoms published by John Wiley & Sons Australia, Ltd.
Références
Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7(suppl 9):S3-S14.
Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res. 2008;20(Suppl 3):S11-S18.
Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011;108:1132-1138.
Gazala S, Tul Y, Wagg A, Widder SL, Khadaroo RG, on behalf of the Acute Care and Emergency Surgery (ACES) GroupQuality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study. World J Emerg Surg. 2013;8:23.
Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC. Prostate volume changes over time: results from the Baltimore Longitudinal Study of Aging. J Urol. 2009;182:1458-1462.
Michel MC, Mehlburger L, Bressel HU, Schumacher H, Schafers RF, Goepel M. Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol. 1998;160:784-791.
Becher KF, Madersbacher S, Michel MC, Olbert P. Management of geriatric patients with benign prostatic hyperplasia. Urologe A. 2020;59:1195-1203.
Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology. 1996;47:48-51.
Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol. 2020;27:44-50.
Park S, Kwon T, Park S, Moon KH. Efficacy of holmium laser enucleation of the prostate in patients with a small prostate (≤30 mL). World J Mens Health. 2017;35:163-169.
Kuntz RM, Lehrich K, Ahyai SA. 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. 2008;53:160-166.
Magistro G, Westhofen T, Stief CG, Weinhold P. A matched-pair analysis of patients with medium-sized prostates (50 cc) treated for male LUTS with HoLEP or TURP. Low Urin Tract Symptoms. 2020;12:117-122.
Gravas S, Cornu, J. N., Drake, M. J., Gacci, M., Gratzke, C., Herrmann, T. R. W., Madersbacher, S., Mamoulakis, C. & Tikkinen, K. A. O Management of Non-neurogenic Male LUTS. Presented at: EAU Annual Congress March 16-20, 2018. EAU Guidelines Edn presented at the EAU Annual Congress Copenhagen 2018 ISBN 978-94-92671-01-1 2018.
Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F. The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol. 2011;29:205-210.
McNeal J. Pathology of benign prostatic hyperplasia. Insight into etiology. Urol Clin North Am. 1990;17:477-486.
Hennenberg M, Stief CG, Gratzke C. Prostatic alpha1-adrenoceptors: new concepts of function, regulation, and intracellular signaling. Neurourol Urodyn. 2014;33:1074-1085.
Fusco F, Creta M, De Nunzio C, Gacci M, Li Marzi V, Finazzi AE. Alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: a systematic review and meta-analysis of urodynamic studies. Neurourol Urodyn. 2018;37(6):1865-1874.
Shapiro E, Lepor H. Pathophysiology of clinical benign prostatic hyperplasia. Urol Clin North Am. 1995;22:285-290.
Simon RM, Howard LE, Moreira DM, et al. Does prostate size predict the development of incident lower urinary tract symptoms in men with mild to no current symptoms? Results from the REDUCE trial. Eur Urol. 2016;69:885-891.
Roehrborn CG. Prostate size: does it matter? Rev Urol. 2000;2:95-98.
Gacci M, Corona G, Vignozzi L, et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU Int. 2015;115:24-31.
Wright EJ, Fang J, Metter EJ, et al. Prostate specific antigen predicts the long-term risk of prostate enlargement: results from the Baltimore Longitudinal Study of Aging. J Urol. 2002;167:2484-2487.
Magistro G, Keller P, Westhofen T, et al. The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. World J Urol. 2021;39(5):1481-1487.
Roehrborn CG. Acute urinary retention: risks and management. Rev Urol. 2005;7(suppl 4):S31-S41.
Tamalunas A, Westhofen T, Schott M, et al. The clinical value of holmium laser enucleation of the prostate in octogenarians. Low Urin Tract Symptoms. 2021;13(2):279-285.
Ghafar MA, Puchner PJ, Anastasiadis AG, Cabelin MA, Buttyan R. Does the prostatic vascular system contribute to the development of benign prostatic hyperplasia? Curr Urol Rep. 2002;3:292-296.
Shah HN, Kausik V, Hegde S, Shah JN, Bansal MB. Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique. J Urol. 2006;175:537-540.
Westhofen T, Weinhold P, Kolb M, Stief CG, Magistro G. Evaluation of holmium laser enucleation of the prostate learning curves with and without a structured training programme. Curr Urol. 2020;14:191-199.
Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol. 2006;49:87-91.
Elshal AM, Elmansy HM, Elhilali MM. Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes. Urology. 2013;81:634-639.