HoLEP: surgical, functional, and quality-of-life outcomes upon extended follow-up

The increased prevalence of patients suffering with Benign Prostatic Hyperplasia (BPH) has highlighted the importance of developing new minimally invasive techniques to treat symptoms as well as ensure long-term evaluations of post operative outcomes.

TURP was previously considered the gold-standard to treat BPH but a newer more advanced technique, Holmium Laser Enucleation of the Prostate (HoLEP) is proving to be at the forefront for effective treatment of BPH with positive ‘long-term surgical, functional and Quality of Life (QoL) outcomes’.

Older style procedures such as the TURP and open surgery are found to ‘trigger gross bleeding, delayed recovery, and a decrease in the quality-o-life (QoL)’whereas in comparison HoLEP is proving to have long-term surgical outcomes from ‘improvements in IPSS, Qmax values and PVR volumes’. The major advantages include ‘retention of sexual function, an acceptable continence rate and improvement in QoL’.

This study involved 114 patients who underwent HoLEP with follow-ups conducted at 1, 3 and 6months post operatively as well as yearly thereafter. Measurements involved ‘IPSS, uroflowmetric data, serum PSA level, PVT volume, QoL, and IEFF data’ evaluations.

Results from the study:

- Mean follow-up time was 42 months, mean patient age 73 years, mean prostate weight was 74g

- Ninety patients were taking oral alpha-blockers to treat BPH pre-operatively

- Mean operation time was 97 min including mean morcellation time of 18min

- The mean weight of enucleated tissue was 29g

- The mean duration of catheterization was 1 day and the mean hospital stay was 1 day

- Significant improvements in all Qmax value, QoL, PVR volume and IPSS were evident during follow up

- Qmax and QoL improved further every subsequent year

- Dramatic decreases in PVR volume and the IPSS occurred immediately after operation

- All improvements were maintained during extended follow-up

- The preoperative and postoperative erectile function index scores were similar – retrograde ejaculation has a high probability after the operation

- Preserved functional results and improved voiding parameters are the principle findings of the study and constitute clinical proof of the utility of HoLEP

HoLEP is proving to be an effective minimally invasive surgical option for men with an enlarged prostate. With greater uptake of this procedure, more studies will be undertaken to show the long-term outcomes and overall patient satisfaction.

Alkan I, Ozveri H, Akin Y, Ipekci T & Alican Y, 2016,‘Holmium Laser Enucleation of the Prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up’, International Brazilian Journal of Urology, Vol.42, pp293-301.