Holmium laser enucleation of the prostate: Comparison of outcomes according to prostate size in 97 Japanese patients

Purpose: To review the outcomes associated with holmium laser enucleation of the prostate (HoLEP) to identify the efficacy and safety in relation to the prostate size in subjects with symptomatic benign prostatic hyperplasia (BPH). Patients and Methods: A retrospective review was conducted of the data from 97 patients who had undergone HoLEP combined with mechanical morcellation. All patients completed both the preoperative and the 6-month postoperative assessment. The morbidity and improvement in the outcome variables were compared in groups classified according to the baseline prostate volume: <50 cm ³ (group 1), ≥50 cm³-<100 cm³ (group 2), and ≥100 cm³ (group 3). Results: The peak urinary flow rate (Q_max), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS) and quality of life (QoL) score all improved significantly after HoLEP, and no significant differences were observed among the groups. The mean total operation times were 70.3, 99.1, and 155.5 minutes for groups 1, 2, and 3, respectively (P < 0.0001 group 1 v group 2 v group 3). The mean times required to complete the enucleation and morcellation were 44.7 v 66.5 v 107.3 minutes (P < 0.0001) and 8.6 v 10.9 v 23.8 minutes (P < 0.0001), respectively. The efficacy for tissue enucleation and morcellation was 0.44 v 0.57 v 0.75 g/min (P < 0.0001) and 2.5 v 3.3 g/min (P = 0.016) v 3.2 g/min (P = 0.035). The mean hemoglobin loss after HoLEP was greater in group 3 than in group 1 (P = 0.036), but it was still low (1.8 g/dL). Major complications included bladder-muscle injury in one patient in group 2 and one in group 3 and long-lasting urinary incontinence in one patient in group 1 and one in group 2 (2.1%). No blood transfusion or transurethral resection syndrome was observed in any of the groups. Conclusions: Holmium laser enucleation is an effective treatment for symptomatic BPH independent of prostate size.