4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 HoLEP techniques – lessons learned Asaf Shvero, MD, 1,2 Edward Kloniecke, MD, 1 Courtney Capella, MD, 1 Akhil K. Das, MD 1 1 Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA 2 Department of Urology, Sheba Medical Center, Ramat-Gan, Israel. Affiliated with Tel Aviv University, Tel Aviv, Israel SHVERO A, KLONIECKE E, CAPELLA C, DAS AK. HoLEP techniques – lessons learned. Can J Urol 2021;28(Suppl 2):11-16. Introduction: Holmium laser enucleation of the prostate (HoLEP) with mechanical tissue morcellation is one of the most effective surgical modalities for the treatment of symptomatic BPH. HoLEP has many advantages over the historical gold standards open prostatectomy (OP) and transurethral resection of the prostate (TURP). HoLEP is an AUA guideline endorsed surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), independent of prostate size. Materials and methods: We provide a detailed presentation of our experience in performing HoLEP in a teaching university hospital, with an emphasis on the surgical technique and its evolution. Results: HoLEP is an efficient and durable procedure, although it is very equipment sensitive and has a relatively long learning curve. HoLEP can be performed by several surgical approaches that can be used according to the specific anatomy of the patient. Advances in laser technology, endoscopic morcellators, and surgical technique has improved the HoLEP procedure in efficiency, hemostasis, and safety. Conclusions: The HoLEP procedure, first introduced in 1998, has undergone significant changes including advancements in laser technology, endoscopic morcellation devices, and modifications to the surgical technique. These advancements have made HoLEP a more effective, more efficient, easier to perform, and easier to learn technique for the surgical management of BPH. The modified 2-lobe and the en-bloc techniques are a natural progression from the classic 3-lobe technique. Key Words: HoLEP, surgical management of BPH Address correspondence to Dr. Asaf Shvero, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction Lower urinary tract symptoms (LUTS) that originate from benign prostatic hyperplasia (BPH) represent a group of chronic urinary conditions, and occur in 15%-60% of men 40 years or older, and 80% of men 70 years or older in the United States. The prevalence of BPH is increasing due to the aging of the population. 1-3 Histological BPH is a proliferation of the glandular elements, smooth muscle, and connective tissue of the transitional zone of the prostate. BPH may progress to benign prostatic enlargement that can either grow outwards from the prostatic urethra or compress the prostatic urethra and eventually lead to bladder outlet obstruction; this, combined with prostatic inflammation, is considered the main cause of LUTS. 4-6 LUTS from BPH is variable, and early symptoms in the course of this disease can often be controlled with medical therapy alone. Patients who continue to suffer from persistent LUTS or develop complications from BPH will eventually require a surgical intervention. Holmium laser enucleation of the prostate (HoLEP) with mechanical tissue morcellation is one of the most effective surgical modalities for the treatment of symptomatic BPH. HoLEP, according to the 11