title: Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates.
  
  
  METHODS
  Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL≤TPV<200 mL), and group C (TPV≥200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery.
  
  
  RESULTS
  A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, ±7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7±36.9 mL and 4.15±4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R(2)=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture.
  
  
  CONCLUSIONS
  HoLEP in patients with an extremely large prostate can be performed efficiently and safely.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Songzhe
authors.initials: S
authors.lastname: Piao
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hahn-Ey
authors.initials: HE
authors.lastname: Lee
authors.affiliation: Department of Urology, National Cancer Center, Goyang, Korea.
authors.forename: Sung Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D066106:Seoul; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen; D006695:Holmium
keywords: Laser therapy; Prostate; Prostatic hyperplasia; Transurethral resection of prostate