Amy E. Krambeck, MD, on patient selection for HoLEP

In this video, Amy E. Krambeck, MD, discusses patient selection for holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia. Krambeck is a professor of urology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Transcription:

How do you approach patient selection for HoLEP, particularly in the context of large prostates or patients with a history of pelvic radiation?

Patient selection for HoLEP is probably the easiest of any of the surgical procedures for BPH, because there's no size limitation for HoLEP. You can do HoLEP on a 20-gram prostate, or you can do HoLEP on a 600-gram prostate, and anything that goes in between. As long as your scope can reach and you have the time to do the morcellation, you can treat the prostate. Post radiation is tricky. With post radiation, we have to be very careful about patient healing. I would say that's one of the few times that I really back off offering surgery for patients. If they've had radiation and they're having persistent bleeding, severe infections, or urinary retention, then we will talk about potentially doing what I call a half HoLEP, and that's where, instead of taking out the whole gland, we'll take out half the gland and leave 1 lobe behind, with the thought that that 1 lobe will provide a somewhat healthy surface for the new tissue to grow on. I found that if you do the whole HoLEP in a patient who's been irradiated, we run the risk of getting calcifications and scar tissue formation or poor wound healing. So we really try to limit the amount of tissue we resect and what we do in patients who've had radiation.

This transcription was AI generated and edited by human editors for clarity.