Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia.

OBJECTIVES: To report our experience with holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of symptomatic benign prostatic hyperplasia (BPH).

METHODS: From January 2000 to May 2001, 155 consecutive patients with BPH underwent HoLEP combined with mechanical morcellation and were followed up for at least 6 months. A pulsed high-powered 80-W holmium-neodymium:yttrium-aluminum-garnet laser was used (power setting 2.0 J/pulse, 35 pulses/s, and 70 W). The enucleated tissue was removed by a transurethral mechanical morcellator.

RESULTS: The preoperative mean prostate volume was 53 +/- 39 cm3; 38.7% of patients had an estimated gland volume greater than 50 cm3; 30.8% had BPH complicated by urinary retention, bladder calculi, bladder diverticula, or urethral stricture. The total mean operative time was 87 +/- 44 minutes, the resected weight was 37 +/- 26 g, and the morcellation efficiency was 1.9 +/- 1.6 g/min. The catheter time was 18 +/- 13.5 hours and the hospital stay 1.5 +/- 1.0 days. No patient needed a blood transfusion or experienced hyponatremia. The patients were followed up for a mean of 13 +/- 5 months (range 6 to 24). The International Prostate Symptom Score, quality-of-life score, and peak urinary flow rate had improved significantly 1 month after HoLEP and continued to improve in the next few months, regardless of whether the gland volume was more or less than 50 cm3.

CONCLUSIONS: HoLEP combined with mechanical morcellation is an efficient surgical intervention for BPH, regardless of gland size.