Holmium Laser Enucleation (HoLEP) vs. Open Prostatectomy for Prostate Adenoma > 100 grams: The Death of Open Prostatectomy?
Lingeman J, Moody J

Large (>100 gram) prostatic adenomas have typically been treated with open surgery. However, endoscopic surgery for BPH has evolved over the past decade and Holmium laser enucleation of the prostate (HoLEP) with transurethral tissue morcellation is potentially applicable to large adenomas. We retrospectively reviewed patient data for HoLEPs performed for >100 gram prostatic adenomas compared with open prostatectomy (OP) patients over the same period. Patient age was similar (HoLEP 74.8 + 3.6 and OP 71.1 + 1.3, P =NS). Pre-op AUA symptom scores were similar (HoLEP 19 + 2.6 vs. OP 22.4 + 2.8, P = NS). Post-operative AUAsymptom scores were significantly decreased (P < 0.004 for both groups). Operative time was comparable (HoLEP 197 + 16.3 min. vs. OP 173 + 12 min. P = NS). Serum sodium was unchanged by HoLEP. Hgbs were not significantly changed in the HoLEP group but dropped significantly in the OP group (mean decrease 2.9 g Hgb + 0.7, P = 0.0003). There were 3 blood transfusions in the OP group and none in the HoLEP group. Resected weight was nearly significantly larger in the HoLEP group (151 + 14 g vs. 106 + 18 g, P = 0.067). LOS was less with HoLEP (2.1 days + 0.3 vs. 6.1 days + 0.9, P = 0.0006). HoLEP is an effective, safe procedure with lower morbidity, duration of catheterization and LOS for large prostatic adenomas previously only treated with open surgery.

Journal of Endourology, Vol. 13 Supplement 1, A146 Sep 1999

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