Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

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Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.2.82 ◽

2020 ◽

Vol 92 (2) ◽

Author(s):

Riccardo Schiavina ◽

Lorenzo Bianchi ◽

Marco Giampaoli ◽

Marco Borghesi ◽

Hussam Dababneh ◽

...

Keyword(s):

Cost Analysis ◽

Prostate Volume ◽

Indirect Costs ◽

Holmium Laser ◽

Transurethral Resection Of Prostate ◽

Open Prostatectomy ◽

Global Cost ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Objective: To assess the economic impact of Holmium laser enucleation of prostate (HoLEP) in comparison with transurethral resection of prostate (TURP) and open prostatectomy (OP). Methods: Between January 2017 and January 2018, we prospectively enrolled 151 men who underwent HoLEP, TURP or OP at tertiary Italian center, due to bladder outflow obstruction symptoms. Patients with prostate volume ≤ 70 cc and those with prostate volume > 70 cc were scheduled for TURP or HoLEP and OP or HoLEP, respectively. Intraoperative and early post-operative functional outcomes were recorded up to 6 months follow up. Cost analysis was carried out considering direct costs (operating room [OR] utilization costs, nurse, surgeons and anesthesiologists’ costs, OR disposable products costs and OR products sterilization costs), indirect costs (hospital stay costs and diagnostics costs) and global costs as sum of both direct and indirect plus general costs related to hospitalization. Cost analysis was performed comparing patients referred to TURP and HoLEP with prostate volume ≤ 70 cc and men underwent OP and HoLEP with prostate volume > 70 cc respectively. Results: Overall, 53 (35.1%), 51 (33.7%) and 47 (31.1%) were scheduled to HoLEP, TURP and OP, respectively. Both TURP, HoLEP and OP proved to effectively improve urinary symptoms related to BPE. Considering patients with prostate volume ≤ 70 cc, median global cost of HoLEP was similar to median global cost of TURP (2151.69 € vs. 2185.61 €, respectively; p = 0.61). Considering patients with prostate volume > 70 cc, median global cost of HoLEP was found to be significantly lower than median global cost of OP (2174.15 € vs. 4064.97 €, respectively; p ≤ 0.001). Conclusions: Global costs of HoLEP are comparable to those of TURP, offering a cost saving of only 11.4 € in favor of HoLEP. Conversely, HoLEP proved to be a strong competitor of OP because of significant global cost sparing amounting to 1890.82 € in favor of HoLEP.

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Holmium laser enucleation of prostate versus minimally invasive simple prostatectomy for large volume (≥ 120 ml) prostate glands: A prospective multicenter randomized study

European Urology ◽

10.1016/s0302-2838(21)00482-6 ◽

2021 ◽

Vol 79 ◽

pp. S131

Author(s):

A.L. Pastore ◽

A. Fuschi ◽

Y. Al Salhi ◽

L. Capone ◽

F. Annino ◽

...

Keyword(s):

Minimally Invasive ◽

Large Volume ◽

Randomized Study ◽

Holmium Laser ◽

Simple Prostatectomy ◽

Laser Enucleation ◽

Holmium Laser Enucleation

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Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Journal of lasers in medical sciences ◽

10.34172/jlms.2020.33 ◽

2020 ◽

Vol 11 (2) ◽

pp. 197-203 ◽

Cited By ~ 1

Author(s):

Amirreza Abedi ◽

Mohammad Reza Razzaghi ◽

Amirhossein Rahavian ◽

Ebrahim Hazrati ◽

Fereshte Aliakbari ◽

...

Keyword(s):

Benign Prostatic Hyperplasia ◽

Specific Antigen ◽

Young Patients ◽

Outlet Obstruction ◽

Prostatic Hyperplasia ◽

Holmium Laser ◽

Safe Procedure ◽

Open Prostatectomy ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

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Preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate

10.21203/rs.3.rs-36182/v1 ◽

2020 ◽

Author(s):

Chun-Hsuan Lin ◽

Ching-Chia Li ◽

Wen-Jeng Wu ◽

Sheng-Chen Wen

Keyword(s):

Operation Time ◽

Holmium Laser ◽

En Bloc ◽

Symptomatic Benign Prostatic Hyperplasia ◽

Clinical Variables ◽

Specimen Weight ◽

History Of ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Preoperative Predictors

Abstract Background To evaluate preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate (HoLEP) Methods We enrolled 135 patients with symptomatic benign prostatic hyperplasia (BPH) treated with en bloc no-touch HoLEP from July 2017 to March 2019 by a single surgeon. Preoperative, perioperative, and postoperative clinical variables were examined. Stepwise linear regression was performed to determine clinical variables associated with enucleation times. Result The average (range) enucleation time was 46.1 (12–220) minutes, and the overall operation time was 71 (18–250) minutes. History of anticoagulation, history of urinary tract infection (UTI), and increasing specimen weight were each significantly associated with increasing enucleation time. No category IV complications were recorded, and all complications were evenly distributed among the groups according to the HoLEP specimen weight. Conclusion En bloc no-touch HoLEP was found to be an efficient and reproducible surgical method for treating BPH. Prostatic gland size was significantly associated with increased enucleation times. Similarly, history of UTI and anticoagulation were correlated with increased operative time.

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