Vol. 42 (2): 293-301, March – April, 2016
Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up
İlter Alkan 1, Hakan Ozveri 2, Yigit Akin 3, Tumay Ipekci 4, Yusuf Alican 5
1 Department of Urology, Okmeydani Teaching and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Acibadem University School of Medicine, Kozyatagi, Istanbul, Turkey; 3 Deparment of Urology, Harran University School of Medicine, Sanliurfa, Turkey; 4 Department of Urology, Baskent University School of Medicine, Alanya Teaching and Research Hospital, Alanya, Antalya, Turkey; 5 Department of Urology, Prosmed Clinic, Nisantasi, Istanbul, Turkey
Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH).
Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05.
Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up.
Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.
Keywords: Prostatic Hyperplasia; Holmium; Laser Therapy; Prostate; Quality of Life