Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy.

OBJECTIVE: To evaluate HoLEP for patients with enlarged prostate (traditionally treated by open prostatectomy) with long-term follow-up.

METHODS: A retrospective analysis of 225 consecutive patients presenting with lower urinary symptoms secondary to benign prostatic hyperplasia with large prostate (>80 cc) who underwent HoLEP. Enucleation time, morcellation time, enucleated tissue weight, catheterization time, hospital stay, voiding outcome parameters, and complications were recorded.

RESULTS: Mean preoperative prostate volume was 126+/-45.1 cc (range 80-351, median 111.2 cc), and resected tissue weight was 86.5 g. Mean follow-up was 31+/-12 months (median 24 months). Mean catheter time and hospital stay were 1.3 and 1.2 days, respectively. Patient symptom scores and peak flow rates were significantly improved immediately after surgery and continued to improve during subsequent follow up. Two patients required intraoperative blood transfusion, and a third patient needed blood transfusion in the early postoperative period for persistent hematuria. Bladder neck contracture and urethral stricture developed in 0.4% and 1.3%, respectively.

CONCLUSIONS: HoLEP represents a safe and effective treatment for patients with symptomatic large prostates. It offers patients who traditionally required open prostatectomy the alternative of being treated endoscopically with minimal blood loss, short catheterization time and hospital stay.