Transurethral Holmium-Laser-Enucleation (HoLEP) of Large Prostate Glands
Kuntz R, Lehrich K

HoLEP enables prostatic tissue to be immediately removed under endoscopical control, similar to TURP, but with less bleeding. For small prostate glands, HoLEP is considered to be an alternative to TURP that reduces hospital stay and costs. We wanted to find out whether or not larger glands could also be successfully treated with HoLEP and, therefore, make HoLEP an alternative to open surgical prostate enucleation. 20 consecutive patients (age: 54-85 yrs., mean: 70, 4 yrs.) with prostate glands of 80-180 (mean: 112,5) grams of weight underwent endoscopical enucleation of the prostate with a Holmium: YAG laser (VersaPulse Select, Coherent, USA): 80 watts 2.0 J/pulse, 40 pulses/sec., and 550 nm bare fibers (SlimLine, Coherent, USA) in direct contact with the prostate lobes which were "peeled off" the capsule in a retrograde fashion. The mean resected weight was 83,7 (55-145) grams, the mean resection time 120,5 (83-170) min., the average resection weight/hour 42 grams, i.e., 0.7 gram/min. The bladder catheter was removed after 1, 2 (1-3) days, and the patients were discharged 3 (1-7) days postoperatively (50 per cent of the patients on the first or second postoperative day). The peak urinary flow increased from 7.3 (1-18) ml/sec. to 25 (14-43) ml/sec., and the residual urine volume decreased from 175,5 (30-500) ml to 10.6 (0-80) ml. One patient needed blood transfusions (2 units), one patient a second HoLEP, and one patient a laser coagulation of a bleeding prostatic artery. We proved that large prostate glands could be successfully treated by HoLEP, with minor blood losses, a low complication rate, and significantly reduced catheterisation time and hospital stay. HoLEP appears to be an alternative to open surgical enucleation for large glands of up to 180 grams of weight.

Journal of Endourology, Vol. 13 Supplement 1, A99, Sep 1999

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