HoLEP improves outcomes in patients with LUTS related to benign prostatic enlargement

Surgery using Holmium laser enucleation of the prostate (HoLEP) to treat lower urinary tract symptoms (LUTS) as a result of benign prostatic enlargement (BPE) improved uroflowmetry, as well as lower mean hospital stays and postoperative catheterizations, as compared with adenomectomy and transurethral resection of the prostate (TURP), according to results presented at the 2022 AUA Annual Meeting.¹

According to the abstract, current literature suggests that HoLEP could replace other techniques as a size-independent surgical treatment for BPE. “Holmium laser enucleation of the prostate is a novel technique for the treatment of lower urinary tract symptoms resulting from benign prostatic enlargement,” the authors explained in the abstract.

Therefore, the investigators aimed to prospectively analyze the improvement in uroflowmetry (Qmax), hospitalization days, postoperative catheterization, urinary incontinence, and erectile dysfunction (ED) in 180 patients treated with TURP and HoLEP for prostates < 90 cc (n = 38 and 51, respectively) and in those treated with open adenomectomy and HoLEP for prostates > 90 cc (n = 51 and 40), from January 2020 to October 2021.

Among those with prostate volumes > 90 cc, HoLEP, compared with adenomectomy, demonstrated a mean improvement in Qmax at 6 to 12 months of 27.4 mL/s vs 20.9 mL/s, respectively (P = .03), a mean hospital stay of 2.4 days vs 4.6 days (P < .001), and a mean postoperative catheterization of 4.1 days vs 10 days (P < .001). Four patients had ED during follow-up after HoLEP, compared with 9 patients treated with adenomectomy.

Among those with prostate volumes < 90cc, HoLEP compared with TURP, demonstrated a mean improvement in Qmax at 6 to 12 months of 23.2 mL/s vs 14.35 mL/s (P = .001), a mean hospital stay of 1.71 days vs 2 days (P = .072), and a mean postoperative catheterization of 3.9 days vs 3.97 days (P = .83). Eight patients had ED during follow-up after HoLEP, compared with 3 patients tested with TURP.

“HoLEP had a greater uroflowmetry improvement compared to open adenomectomy and TURP,” the investigators concluded. “The mean hospital stay and postoperative catheterization days were reduced compared to open adenomectomy, but there were no differences in this aspect with TURP.”

Reference

1. Beltran M, Pallas Y, Povo I, et al. Surgical Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Enlargement by Holmium Laser Enucleation of the Prostate Versus Transurethral Resection of the Prostate and Open Adenomectomy. Journal of Urology. 207(55);5S:e1037. doi:JU.0000000000002669.05