Holmium laser enucleation of the prostate for prostates larger than 175 grams.
OBJECTIVE
Open simple prostatectomy has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH) of large prostates because traditional endoscopic techniques have not proven either effective or feasible. We present our experience with holmium laser enucleation of the prostate (HoLEP) for glands >175 cc.


METHODS
An Institutional Review Board approved prospective database has been maintained since January 1999 for all HoLEP procedures. The database was reviewed retrospectively for patients who underwent HoLEP for BPH with a preoperative transrectal ultrasonography (TRUS) volume of >175 cc.


RESULTS
From January 1999 to November 2008, we identified 57 patients with a mean pretreatment TRUS volume of 217.8 cc (range 175-391 cc). Preoperative retention was present in 30 patients. Preoperative mean prostate-specific antigen level was 14.6 ng/mL, mean American Urological Association (AUA) symptom index was 19.0, and mean peak flow (Qmax) was 8.2 mL/sec. Mean hospital stay was 26 hours, and postoperative catheterization was 18.5 hours (range 6-96 hrs). All patients were able to void after catheter removal. Mean enucleated tissue weight was 176.4 g (range 48-532.2 g). At 6-month follow-up, AUA symptom index was 6.5, mean PSA level was 0.78 ng/mL, and Qmax was 18.5. During the follow-up period, no patient needed catheterization or had persistent incontinence.


CONCLUSIONS
Even in the large prostate gland, HoLEP provides a satisfactory outcome with low morbidity. HoLEP is the only endoscopic technique that allows for tissue removal comparable to that of open prostatectomy for such patients.
Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46202, USA.
Amy E
AE
Krambeck
Shelly E
SE
Handa
James E
JE
Lingeman
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011182:Postoperative Care; D011300:Preoperative Care; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011860:Radiography, Abdominal; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D017430:Prostate-Specific Antigen