The New England Section of the American Urological Association
Search Meeting Site
QUICK LINKS
    NEAUA Main Site
    Annual Meeting Home
    Past & Future Meetings
 


 


Back to 2014 Annual Meeting Abstracts


Holmium Laser Ablation versus Enucleation for the Surgical Treatment of Benign Prostatic Hypertrophy
Sanchita Bose, MD, Tony Nimeh, MD, Lori B. Lerner, MD.
VA Boston Healthcare System, West Roxbury, MA, USA.

BACKGROUND:
There are few published studies that compare holmium laser ablation to enucleation, making it hard to determine if one is better than the other. As both procedures are performed at VA Boston Healthcare System, we compared our results of holmium laser ablation of the prostate (HoLAP) to holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction.
METHODS:
Total 193 patients with documented moderate-severe LUTS underwent either HoLEP or HoLAP from 2008-2014. The majority of the procedures
were performed by residents and supervised by the same experienced
surgeon. As transrectal ultrasound was not completed on most patients, final decision to perform HoLAP vs HoLEP was made intra-operatively
based on prostate characteristics (i.e. intravesical prostatic protrusion vs
high bladder neck vs lateral lobar hypertrophy, etc) . However, pre-operative digital rectal exam (DRE) estimation was recorded. Operative and resection times, as well as intraoperative complications and re-operations, were recorded. Change in peak flow, using urodynamics and/or uroflometry, was recorded when possible. As no tissue is resected with HoLAP, the change in prostate-specific antigen (PSA) pre and post operatively was used as a surrogate for prostate size and gland reduction.
RESULTS:
After excluding for prostate cancer and bladder cancer involving the bladder neck/prostatic urethra, 185 patients were available for evaluation. A total 65 patients underwent HoLAP and 120 underwent HoLEP. Comparisons were made for patients in whom
there were complete pre and post operative values. The estimated pre-operative prostate volume on DRE was 37 grams (±SD 17) vs. 48 grams (±SD 27) for HoLAP and HoLEP, respectively. There was a mean decrease in PSA of 2.9 ng/ml (52% reduction) in the HoLEP group, and a decrease of 1.4 ng/ml (45% reduction) in the HoLAP group. HoLEPs had 5 recorded intraoperativecomplications, morcellator malfunction in all.
There were no intraoperative complications with HoLAP. The HoLEP group had 10 re-operations: 4 for prostatic regrowth; 4 to complete morcellation; 1 for continued bleeding from remaining prostate;
1 as planned second stage due to prolonged time required to enucleated oneprostate lobe. No HoLAP patientsrequired re-operation.
The mean operative time for HoLEP was 37 minutes longer than
for HoLAP (116 minutes ± SD 68.7 vs 79 minutes ± SD 42). All patients experienced significant improvements in their maximum flow: HoLAP group had mean increase in Qmax of 7.6 ml/minute (from 6 to 13.6 ml/min); HoLEP group increased 11 ml/minute (from 7 to 18 ml/min).
CONCLUSIONS: Very few surgeons perform both HoLAP and HoLEP in their practice. Our study shows that in properly selected patients, outcomes are excellent for both procedures. Not surprisingly, changes in PSA and flow were more pronounced for HoLEP as enucleation removes more tissue than HoLAP. However, operative time was significantly less for HoLAP, largely due to elimination of morcellation from the procedure. These results suggest that surgeons who use a proper holmium ablative technique, and appropriately select patients, very good outcomes for their patients can be achieved.


Back to 2014 Annual Meeting Abstracts


© 2024 New England Section of the American Urological Association. All Rights Reserved. Privacy Policy.