Investigators evaluate early apical release HoLEP for BPH

In this video, Daniel J. Heidenberg, MD, describes the background for the recent Urology paper, “The Impact of Standard vs Early Apical Release HoLEP Technique on Postoperative Incontinence and Quality of Life.” Heidenberg is an endourology fellow at Mayo Clinic in Phoenix, Arizona.

Transcription:

Please describe the background for this study.

For a long time, Mayo Clinic has been involved in doing holmium laser negotiation of the prostate. Dr. Humphreys brought his expertise over that he learned at Indiana University, and he's had a program ongoing for a long time. There are a lot of people who are very happy with the way HoLEP has been done for a long time. The original paper came out in 1998, by Dr. Gilling, describing exactly how it is that a standard HoLEP was done. And then, over time, that was slowly taken over by more and more urologists throughout the world. People out there started to ask, is this another gold standard that could compete with TURP? That's the background that that I'm entering in from the Mayo Clinic. The one thing that I would say some patients found as a drawback to the procedure done the original way was that they're experiencing issues with stress incontinence, much like in the way that some people have after robotic prostatectomy. I think that that may be for a couple of reasons. Though we don't 100% know the exact methodology, there are a lot of thoughts out there about what could have been contributing. And so the technique by which we adopted to try to address that came out of a lot of these observational studies that had been done over the last 6 or 7 years that had been presented at conferences like the World Congress of Endourology, and there were a lot of people that made new "how to modify" on the original technique, "how to" to make the incontinence rate a little bit better. In the literature, there had been a lot of different things that have been discussed, such as grams of tissue resected, and prostate volume, or perhaps a patient's age or medical comorbidities could have contributed to the development of stress incontinence afterwards, but technique wasn't really addressed until the mid 2010s. What we noticed was that there was only 1 study out there that was done, it was published in the Journal of Endourology in 2020, that really looked at outcomes from changing techniques. We thought we could do a similar sort of study with hopefully comparable to longer follow-up as well as adding some things like propensity score matching to allow us to potentially enhance the overall body of literature supporting what I think might be a helpful change for people involved in doing things like HoLEP. But I also don't think, and I think some of my mentors would agree, that it's just limited to HoLEP. From other studies done in large meta-analyses, you can see that sometimes it's quoted up to as high as 5% of temporary stress incontinence after TURPs, which I know every urologist is doing all over the United States and the world. And so we're really at the heart of it, trying to figure out how we can get that number as close to 0 as possible to really try to improve our patients' quality of life. Our idea spawned in 2021 to 2022. Our urology department with Dr. Cheney and Dr. Humphreys were all involved in saying, "I think this may be something we need to consider adopting."

This transcription was edited for clarity.