Holmium Laser Enucleation of the Prostate: Initial Report of the First 230 Egyptian Cases Performed in a Single Center

Objectives

To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center.

Methods

A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 ± 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 ± 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q_max, PVR, and International Prostate Symptom Score.

Results

Weight of prostate chips retrieved after morcellation was 78.6 ± 61.3 g (range: 10-350), with enucleation time 102.2 ± 55.4 minutes and morcellation time 19.3 ± 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q_max increased from 7.7 ± 2.3 to 25.8 ± 10.1 mL/s (P ≤.001), mean PVR decreased from 171.3 ± 126.3 to 41.6 ± 45.7 mL (P ≤.001), and mean international prostate symptom score improved from 17.3 ± 6.7 to 6.6 ± 3.4 (P ≤.001). These improvements were sustained throughout a 12-month follow-up period. Temporary irritative symptoms were evident in 34.6% and stress urinary incontinence in 9%, both of which were self-limited on medical treatment and Kegel exercises, respectively. Only 1 patient with pancytopenia required blood transfusion and there was no case for transurethral resection syndrome.

Conclusions

HoLEP is a safe and an effective modern modality for the treatment of symptomatic BPH regardless of the gland size, with satisfactory clinical outcome.