Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria

Abstract Background Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world. Methods A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented. Results There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis. Conclusions The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.

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Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽

10.1186/s12894-021-00797-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giorgio Bozzini ◽

Matteo Maltagliati ◽

Umberto Besana ◽

Lorenzo Berti ◽

Albert Calori ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Randomized Study ◽

Urine Volume ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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Day-case holmium laser enucleation of the prostate: feasibility, safety and predictive factors

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0039 ◽

2018 ◽

Vol 100 (6) ◽

pp. 475-479 ◽

Cited By ~ 6

Author(s):

S-M Lee ◽

K Gordon ◽

R McMillan ◽

F Crystal ◽

P Acher

Keyword(s):

Hospital Stay ◽

Predictive Factors ◽

Length Of Hospital Stay ◽

Day Length ◽

Holmium Laser ◽

Day Case ◽

Day Case Surgery ◽

Case Surgery ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Introduction Transurethral resection of the prostate has remained the most common operation for bladder outlet obstruction in the UK, but it is associated with potential morbidity and median two-day length of hospital stay. Holmium laser enucleation of the prostate (HoLEP) provides an alternative procedure. Provision of day-case HoLEP would improve patient care through increased efficiency. We assessed the feasibility and safety of day-case HoLEP and examined predictive factors for increased length of hospital stay. Materials and methods Patients presenting for HoLEP by a single surgeon from September 2013 to September 2016 were considered for day-case surgery. Patients were discharged following assessment by the operating surgeon and met predetermined discharge criteria. Factors contributing to day-case success were identified. Results In total, 210 patients (mean age 70.3 ± 8.5 years) underwent HoLEP, with 74 (35.3%) discharged as true day-cases and a further 84 (40.0%) discharged within 23 hours. Readmission rate was 5.5%, with all complications Clavien–Dindo grade I or II. Factors associated with successful day-case operation included low-volume prostates (≤ 40 g) (odds ratio, OR, 3.097, 95% confidence interval, CI, 1.619–5.924, P = 0.0001) and morning surgical lists (OR 6.124, 95% CI 2.526-14.845, p<0.001). Discussion and conclusion Day-case HoLEP is both feasible and safe, with low readmission rates. Two factors were significantly associated with successful day-case surgery: small volume prostate and morning theatre lists. Addressing these factors through preoperative planning can improve day-case surgery rates and improve bed throughput.

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MP02-14 FIRST POST-VOID RESIDUAL URINE VOLUME FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE: PREDICTOR OF DE NOVO URINARY INCONTINENCE

The Journal of Urology ◽

10.1016/j.juro.2017.02.110 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Jun Seok Kim ◽

Dong Hoon Yoo ◽

Dong Hoon Lim ◽

Myung Ki Kim ◽

Hee Jong Jeong ◽

...

Keyword(s):

Urinary Incontinence ◽

De Novo ◽

Urine Volume ◽

Holmium Laser ◽

Residual Urine Volume ◽

Residual Urine ◽

Laser Enucleation ◽

Holmium Laser Enucleation

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Faculty Opinions recommendation of The Role of Prostate Specific Antigen Monitoring after Holmium Laser Enucleation of the Prostate.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736558641.793569311 ◽

2020 ◽

Author(s):

Juan Palou Redorta ◽

Iván Schwartzmann

Keyword(s):

Prostate Specific Antigen ◽

Specific Antigen ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation

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COMPARISON OF CLINICAL RESULTS BETWEEN TUR-P AND HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HoLEP) BASED ON THE INITIAL EXPERIENCE

The Japanese Journal of Urology ◽

10.5980/jpnjurol1989.99.543 ◽

2008 ◽

Vol 99 (3) ◽

pp. 543-550 ◽

Cited By ~ 1

Author(s):

Toshihide Shishido ◽

Kaori Enomoto ◽

Naoyuki Fujita ◽

Atsushi Suzuki ◽

Kenjiro Hayashi ◽

...

Keyword(s):

Clinical Results ◽

Holmium Laser ◽

Initial Experience ◽

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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