title: [Holmium laser enucleation of the prostate (HOLEP) for small, large and giant prostatic hyperplasia. Practice guidelines. Experience of more than 450 surgeries].
abstract: BACKGROUND
  and objectives. Most of modern endoscopic procedures (e.g., TURP) are only confined to small and medium-sized glands (up to 80 cm3), but not HoLEP, which allows to enucleate large and extremely large prostates (200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes.
  
  
  METHODS
  s. A total of 459 patients were divided into three groups: Group 1 included 278 patients (prostate volume <100 cm3); mean prostate volume, 70.8+/-16.1 cm3; IPSS, 18.7+/-5.5; QoL, 4.1+/-0.5; Qmax, 6.2+/-1.5 mL/s; post-voided residual volume, 64.2+/-30.5 mL. Group 2 included 169 patients (prostate volume 100-200 cm3); mean prostate volume, 148.1+/-25.2 cm3; IPSS, 19.7+/-3.3; QoL, 4.2+/-0.7; Qmax, 5.9+/-0.7 mL/s; post-voided residual volume, 70.9+/-20.1 mL. Group 3 included 12 patients (prostate volume >200 cm3); mean prostate volume, 230.1+/-18.1 cm3; IPSS, 19.5+/-4.5; QoL, 4.1+/-0.3; Qmax, 4.7+/-0.9 mL/s; post-voided residual volume, 72.3+/-10.9 mL. All the patients underwent HoLEP from 2013 to 2015. For the prostate to be enucleated, a 100-W laser system, 550-micron end-fire fiber, and a morcellator for tissue evacuation were used.
  
  
  RESULTS
  The average duration of surgery in Group 1 was 56.5+/-10.7 min; in group 2, 96.4+/-24.9 min; in Group 3, 120.9+/-35 min. The average duration of morcellation in Group 1 was 37.5+/-7.3 min; in Group 2, 63.3+/-11.2 min; in Group 3, 84.0+/-25.6 min. The efficiency of enucleation in Group 3 (1.70 g/min) was significantly higher (p < 0.05) than in Group 1 (1.05 g/min) and Group 2 (1.23 g/min). Similar results were obtained for the efficiency of morcellation. It was lower in Group 1 and Group 2 (1.58 and 1.87 g/min, respectively) than in Group 3 (2.45 g/min) (p<0.05). In order to compare the long-term results of HoLEP for prostates of different sizes, all the 459 patients were followed up for 18 months. IPSS, Qmax, QoL, and post-voided residual volumes were measured. There were no significant differences (p>0.05) in the postoperative outcomes for 1, 3, 6, 12, and 18 months after surgery.
  
  
  CONCLUSIONS
  It follows from our two years experience that HoLEP is a safe, highly efficacious and a size-independent procedure, which is why it has become a new gold standard for treatment of extremely large prostatic hyperplasia in our clinic.
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: D V
authors.initials: DV
authors.lastname: Enikeev
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: P V
authors.initials: PV
authors.lastname: Glybochko
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: Yu G
authors.initials: YG
authors.lastname: Alyaev
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: L M
authors.initials: LM
authors.lastname: Rapoport
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: M E
authors.initials: ME
authors.lastname: Enikeev
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: D G
authors.initials: DG
authors.lastname: Tsarichenko
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: N I
authors.initials: NI
authors.lastname: Sorokin
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: R B
authors.initials: RB
authors.lastname: Sukhanov
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: A M
authors.initials: AM
authors.lastname: Dimov
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: O Kh
authors.initials: OK
authors.lastname: Khamraev
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: D S
authors.initials: DS
authors.lastname: Davydov
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: M S
authors.initials: MS
authors.lastname: Taratkin
authors.affiliation: FSBEI HPE First MSMU n.a. I.M. Sechenov of RMH.|SRI of Uronephrology and Human Reproductive Health.
authors.forename: R R
authors.initials: RR
authors.lastname: Simberdeev
mesh_terms: D006801:Humans; D053685:Laser Therapy / Q000379:methods; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*
keywords: benign prostatic hyperplasia; bladder outlet obstruction; holmium laser enucleation of the prostate; laser