3rd Annual Jefferson Urology Symposium: Men’s Health Forum
© The Canadian Journal of Urology TM : International Supplement, August 2020 Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia Akhil K. Das, MD, Timothy M. Han, BA, Thomas J. Hardacker, MD Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA DASAK, HANTM, HARDACKERTJ. Holmiumlaser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatichyperplasia. Can JUrol 2020;27(Suppl 3):44-50. Introduction: Holmium laser enucleation of the prostate (HoLEP) has become an increasingly common surgical management option for treatment of symptomatic benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) has long been considered the gold standard, contemporary literature and newer guidelines indicate that HoLEP has become the new size-independent endoscopic gold standard for surgical BPH treatment. Materials and methods: We provide a review and update on current HoLEP surgical techniques, outcomes, safety, and durability according to the growing body of literature. Results: The current body of literature and guidelines indicate HoLEP as a safe and effective surgical treatment for symptomatic BPH regardless of prostate size. Durable long term subjective and objective outcomes have been demonstrated in previous studies, extending beyond 10 years. Conclusions: HoLEP continues to demonstrate durable long term efficacy for treating patients suffering from lower urinary tract symptoms (LUTS) due to BPH. The American Urological Association (AUA) guidelines recommend its use as a size-independent endoscopic treatment option. HoLEP has proven itself to be the new gold standard in surgical treatment for LUTS secondary to BPH with the ability to endoscopically treat prostates independent of size, with durable long term outcomes. Key Words: HoLEP, BPH, LUTS Address correspondence to Dr. Akhil Das, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 1112, Philadelphia, PA 19107 USA Introduction Benign prostatic hyperplasia (BPH) represents the most common benign neoplasm in American men, with almost 3 in 4 affected by the seventh decade of life. 1 Proliferation of prostatic glandular epithelium, smooth muscle and connective tissue results in prostatic urethral compression, manifesting as bladder outlet obstruction (BOO) and lower urinary tract obstructive symptoms (LUTS). 2 Historically, surgical management of BPH has been transurethral resection of the prostate (TURP) and has served as the gold standard to which all other treatments are compared. 3 Monopolar TURPdoes carry the risk of TUR syndrome, which occurs between 0.78% and 1.4% of cases, 4 and results in neurologic disturbance, pulmonary 44 edema, cardiovascular compromise, and potentially death secondary to dilutional hyponatremia. 5 TURP can also have increased bleeding risk in those on anticoagulation and can be challenging in men with larger prostates. In the current current American Urological Association (AUA) guidelines for the surgical management of BPH, TURP is one of the options for prostates less than 80 grams (g). For larger prostates (> 80 g), open simple prostatectomy (OSP) has traditionally been the main surgical treatment option, though laser enucleation has become widely adopted as well. The holmium laser has been employed to treat BPH after its successful use in treating urinary calculi. 6 This laser enables the surgeon to enucleate the transition zone of the prostate from the surgical capsule by taking advantage of existing anatomic planes. In doing so, significantly improving total tissue removal compared to TURP and is less invasive than OSPwhile maintaining equivalent outcomes.
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