Yale urologist hails benefits of HoLEP for BPH

Tom Massey’s quality of life has changed considerably in the last several months. Before his outpatient prostate reduction surgery with Daniel Kellner, MD, associate clinical professor at Yale School of Medicine urology, Massey was up six to seven times a night to urinate. He also describes an intense urgency. “If I had to go, I often had to pull over on the side of the road – I could not wait.”

Now the 55-year-old says it’s unusual for him to get up once a night. He is sleeping better and is completely off his medication for an enlarged prostate [BPH]. He was back to work just five days after the procedure. “It was a life changer!” exclaims Massey.

And that is exactly why Dr. Kellner, Yale Medicine urologist, continues to advocate for the fairly new procedure he started performing in 2019, called holmium laser enucleation of the prostate [HoLEP]. “It’s the most satisfying of all the things I do as a surgeon,” says Kellner. “The benefits are so dramatic and often immediate.”

Kellner recently performed his 500th HoLEP and continues to be the first and only provider in Connecticut offering the procedure. He’s not resting on laurels, though. Kellner and colleagues have just completed a study, not yet published, which points to further benefits of HoLEP and may help to contribute to refinements of the procedure.

The pilot study of 40 sexually active men who had middle lobe only enucleation in Kellner’s care shows approximately 90% ejaculation preservation—an advance over the traditional HoLEP procedures. This is in addition to “significantly improved” urinary function after the HoLEP, which has been true from the start. These results are noteworthy, says Kellner, since HoLEP is one of the only minimally invasive treatments for patients with BPH that can be performed independent of their prostate size. Other therapies known for preserving ejaculatory function [i.e. UroLift or Rezûm] tend to be most effective on smaller prostates.

Kellner’s already seen enough benefits from HoLEP to want to expand the care to others. He reports most patients go home the same day of the procedure, often without pain medication. Also, “there’s an exceptionally low retreatment rate compared to other procedures for BPH,” reports Kellner, who hopes to broaden the HoLEP training he already does with resident physicians. He sees Yale Urology becoming a destination for trainees, patients, and even medical device manufacturers and developers. “I see industry folks eventually coming to us to run clinical trials.”

Massey says he has no doubts concerning the effectiveness of HoLEP. Besides the experience of a healthier bladder and prostate, he can personally testify to fewer erectile dysfunction issues, as well. Massey admits that has been a pleasant “side effect.”

“I can’t imagine life without this procedure now.”