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Holmium Laser Enucleation of the Prostate (HoLEP)for glands larger than 200 grams
Jessica A. Mandeville, MD, Ronald S. Boris, MD, Lori Rawlings, RN, James E. Lingeman, MD.
Indiana University Health / IU Health Physicians, Indianapolis, IN, USA.

BACKGROUND:
Holmium laser technology allows for enucleation of very large prostate glands. Here we describe our experience with HoLEP for glands ≥ 200 grams.
METHODS: Between January 1999 and February 2011, 58 patients with glands ≥ 200 grams underwent HoLEP. All procedures were performed by one surgeon (JEL). Residents/fellows assisted in all cases.
RESULTS:
Mean patient age was 72.6 years. Mean pre-operative characteristics: transrectal ultrasound volume of 218 grams, AUA symptom score (AUASS) of 18.9, Qmax of 7.5 ml/sec, post-void residual (PVR) of 237.6 cc and PSA of 19.9 ng/mL. Twenty-nine percent required catheterization pre-operatively. Mean enucleation and morcellation times were 86.7 and 49.3 min respectively. Mean enucleation and morcellation efficiency were 2.8 and 6.3 g/min. Mean weight of tissue resected was 213.4 grams. Two patients (3.4%) required perineal urethrostomy to complete the procedure. Eight patients (13.8%) had concomitant procedures (bladder neck incision (2), cystolithopaxy (5), bladder biopsy (1)). One patient (1.7%) required cystotomy for tissue retrieval. One patient required same-day take back for clot evacuation and one patient required take back 48 hours post-operatively to complete morcellation. Mean pre- and post-operative hemoglobin were 14.1 g/dL and 11.5 g/dL, respectively. Two patients (3.4%) required transfusion. Mean catheterization time was 19.9 hours and all patients voided spontaneously after catheter removal. Mean AUASS at 12 months was 3.86 and mean PVR at 12 months was 34.9 cc. Mean PSA at 6 months was 0.85 ng/ml (mean reduction 87.4%). To date, one patient (1.7%) developed a urethral stricture and 0 patients required secondary procedures.
CONCLUSIONS:
HoLEP can be safely performed in patients with glands ≥ 200 grams with results equivalent or superior to open simple prostatectomy.


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