3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 (n = 18), transurethral incision of the prostate (n = 9), and open simple prostatectomy (n = 7). For the tested individual domains, significant differences were noted in urinary intermittency (p < 0.001), weak stream (p = 0.003), straining (p < 0.001), and QoL (p = 0.001), in favor of HoLEP. Additionally, HoLEP demonstrated a significant advantage in voiding (p = 0.02) and QoL domains (p = 0.03) using ICSmaleSF, as well as the lowest rates of patient regret. Despite endorsement in the literature and AUA guidelines,wideadoptionofHoLEPandimplementation in the urology community has been somewhat limited. This ismost likely secondary to the steep learning curve of the HoLEP procedure. Relatively few US urologists receive HoLEP training during residency and learning the technique afterward can be challenging. Robert et al conducted a prospective, multicenter observational study involving surgeons experienced in TURP and OSP, but with no previous HoLEP experience. 54 Nearly half of the centers ultimately chose to either abandon the HoLEP technique before the end of the study or to not continue performing HoLEP at the conclusion. In a systematic review assessing the HoLEP learning curve, Kampantais et al showed that HoLEP has an acceptable learning curve with a proposed number of 25-50 cases. 55 A structured mentorship program and the use of simulation can greatly reduce the number of cases needed. A separate systematic review focusing on the complications of the HoLEP learning curve demonstrated that complication rates are similar or lower to those reported by traditional techniques. 56 Conclusions Overall, HoLEPhas proven to be an extremely effective, safe, and durable treatment for patients suffering from LUTS due to BPH. The AUA guidelines highlight this by recommending HoLEP as a size-independent treatment option for those who are candidates for surgical treatment. The literature showsHoLEP to be an equivalent if not superior surgical solution to TURPand OSPwith a growing body of research comparingHoLEP favorably to other techniques such as RSP. While there are some limitations to this technique, including high rates of retrograde ejaculationanda steep learning curve, HoLEP has a large body of literature demonstrating its efficacy, long term durability, and favorable risk profile. HoLEPoffers a surgical management option for patients who may not be optimal candidates for other procedures based on prostate size, age, or bleeding risk. Given its widespread utility and durable outcomes, HoLEP is quickly becoming the new gold standard in the treatment of surgical BPH. 49 Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia References 1. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2008;179 (5 Suppl):S75-S80. 2. Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol 2014;30(2):170-176. 3. FosterHE, DahmP, Kohler TS et al. Surgicalmanagement of lower urinary tract symptoms attributed tobenignprostatic hyperplasia: AUA guideline amendment 2019. J Urol 2019;202(3):592-598. 4. Zepnick H., Steinbach F., Schuster F. Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): an analysis of efficiency and complications in 1015 cases. 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