Holmium laser enucleation of the prostate: a comparison of efficiency measures at two institutions.
OBJECTIVE
Holmium laser enucleation of the prostate (HoLEP) is perceived to be technically difficult, time consuming, and inefficient. We assessed the efficiency of HoLEP by documenting the technical features of the procedure at two hospitals located on different continents.


METHODS
A retrospective analysis of all patients who underwent HoLEP at the Methodist Hospital of Indiana and Tauranga Hospital in New Zealand was performed. A series of 40 patients from the Indiana cohort were pair-matched, by the weight of prostate tissue retrieved, with 40 patients from the New Zealand cohort. Enucleation time and morcellation time were compared in the two groups.


RESULTS
The mean weight of the tissue retrieved from the Indiana cohort was 27.1 g and that from the New Zealand cohort was 22.9 g (P = 0.41). The mean enucleation times were 47.6 minutes and 29.2 minutes, respectively (P < 0.001). The mean morcellation times were 9.9 minutes and 7.7 minutes (P = 0.201). The mean rates of enucleation were 0.58 g/min and 0.71 g/min (P = 0.17). The mean rates of morcellation were 3.4 g/min and 4.3 g/min (P = 0.20). The HoLEP efficiency increased as a function of gland size (R(2) = 0.56).


CONCLUSIONS
Holmium laser enucleation of the prostate is a reproducible technique, as there is little variation in efficiency from one surgeon to another. Furthermore, the efficiency of HoLEP increases as prostate size increases, which suggests that HoLEP may be an ideal treatment for men with large prostates.
Methodist Hospital Institute for Kidney Stone Disease, and Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Samuel C
SC
Kim
Brian R
BR
Matlaga
Ramsay L
RL
Kuo
Stephanie L
SL
Watkins
Katie M
KM
Kennett
Peter J
PJ
Gilling
James E
JE
Lingeman
D006695:Holmium; D006801:Humans; D007196:Indiana; D053685:Laser Therapy; D008297:Male; D009520:New Zealand; D009929:Organ Size; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
D006695:Holmium