Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients.
OBJECTIVE
A prospective study to assess safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE).


METHODS
Between January 2000 and July 2003, 330 consecutive patients underwent HoLEP at our institution. All patients were pre-operatively assessed with transrectal ultrasound gland volume evaluation, maximum urinary flow rate (Q(max)), international prostate symptoms score (IPSS), and the single-question quality of life (QoL). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 1-, 3-, 6-, 12-, 18-, 24-, and 36-mo follow-up with the same examinations.


RESULTS
Patients' mean age was 66+/-8.1 yr; prostate volume was 62+/-34 cc. Enucleation time was 45.4+/-22.9 min and morcellation time 17.3+/-14 min, whilst resected weight was 40+/-27.5 g. Catheter time was 23+/-14.7h and hospital stay was 48+/-26 h. Mean serum hemoglobin and sodium did not drop significantly from baseline after the procedure (p=013). A significant improvement occurred in Q(max) (25.1+/-10.7 ml/s), IPSS (0.7+/-1.3), and QoL (0.2+/-0.5) at the 3-yr follow-up compared with baseline (p<0.05). Twenty-eight percent of patients complained of irritative urinary symptoms, typically self-limiting after 3 mo; transient stress incontinence was reported in 7.3% of patients. Nine patients (2.7%) had persistent BOO, requiring reoperation.


CONCLUSIONS
HoLEP represents an effective and safe surgical intervention. The relief from BOO also proved to be durable after 3-yr follow-up. The present report adds to the evidence that HoLEP could be the standard "size-independent" surgical treatment for symptomatic BPE-related BOO.
Vavassori
Ivano
I
Urology Unit, Humanitas-Gavazzeni Hospital, Bergamo, Italy.
Valenti
Sergio
S
Naspro
Richard
R
Vismara
Alberto
A
Dell'Acqua
Vincenzo
V
Manzetti
Alberto
A
Hurle
Rodolfo
R
D000368:Aged; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D053844:Lasers, Solid-State; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics