Holmium Laser Enucleation of the Prostate (HoLEP) for Prostates Greater Than 100 ml in Volume
Gilling P, Kennett K, Fraundorfer M

HoLEP combined with mechanical tissue morcellation has shortened the operating time and simplified the procedure of Holmium Prostatectomy. This procedure is the endourologic equivalent of open prostatectomy in that the laser fiber is used instead of the index finger to enucleate the entire adenoma. Its use in large prostates is presented. 36 patients with ultrasound prostate volumes > 100ml are presented. The patients were assessed with peak flow rates (Qmax) and American Urological Association (AUA) symptom scores pre-operatively. Intra-operative parameters included laser time, morcellation time, kJ's used, tissue retrieved (g), catheter time, and hospital time. The patients were assessed at 1, 3, 6, and 12 months postoperatively. The mean age was 74.1 (52-90) years. Ten patients were in retention pre-operatively. The mean ultrasound volume was 129.5 (102-247) ml. The kilojoules used were 209.6 (78-440) kJ. The laser time was 67.2 (24-146) mins and the morcellation time was 16.5 (4.65) mins. The mean path weight was 63.5 (102-247) g. Post-operative irrigation was required in 4 patients. The catheter time was 19.7 (10-44) hours and the hospital time was 28.8 (17-48) hours. One patient was recatheterised at 28 days. The flow rates, symptom scores and adverse events will be presented. HoLEP can be safely employed in very large prostates with minimal morbidity. This procedure represents an endourological alternative to open prostatectomy in prostates > 100mls.

Journal of Endourology, Vol. 13 Supplement 1, A28, Sep 1999

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