4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 HoLEP: the new gold standard for surgical treatment of benign prostatic hyperplasia Asaf Shvero, MD, 1,2 Brian Calio, MD, 1 Mitchell R. Humphreys, MD, 3 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 3 Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA SHVERO A, CALIO B, HUMPHREYS MR, DAS AK. HoLEP: the new gold standard for surgical treatment of benign prostatic hyperplasia. Can J Urol 2021;28(Suppl 2):6-10. Introduction: Transurethral resection of the prostate (TURP) was considered the “gold standard” surgical treatment for medication-refractory benign prostatic hyperplasia (BPH) for decades. With the desire to reduce hospital stay, complications, and cost, less invasive procedures gained usage in the 1990’s. With the advent of a soft tissue morcellator, holmium laser enucleation of the prostate (HoLEP) was introduced as an efficacious alternative to TURP and due to its advantageous side effect profile compared to TURP, has grown in popularity ever since. HoLEP has become a size-independent guideline endorsed procedure of choice for the surgical treatment of BPH. Materials and methods: We provide a review on the evolution of HoLEP as a gold standard compared to the historical reference procedures for BPH, and provide a review of emerging laser technologies. Results: A growing body of literature has shown HoLEP to be a safe and efficient procedure for the treatment of BPH for all prostate sizes. Long term studies have proven the durability of HoLEP, as a first line surgical therapy for BPH. Conclusions: HoLEP is a proven modality for the surgical treatment of BPH. It can be performed on patients with high risk for postoperative bleeding, or after previous prostate reducing procedures. HoLEP is the only procedure that is AUAguideline-endorsed for all prostate sizes for the surgical treatment of BPH. Given these considerations, HoLEP has become the new gold- standard for the surgical treatment of BPH. Key Words: benign prostatic hyperplasia, HoLEP, TURP Address correspondence to Dr. Asaf Shvero, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction Benign prostatic hyperplasia (BPH) is the most common benign lesion affecting men in the United States, affecting 3 in 4 men by the 7 th decade of life. 1 BPH becomes clinically significant when it results in lower urinary tract symptoms (LUTS), and affects between 50%-75% of men older than 50 years, and 80% of men older than 70 years. 2 While watchful waiting and medical treatment may be suitable 6 for managing mild symptoms, surgical treatment remains the cornerstone of treatment in the disease for moderate and severe symptoms. 3 Historically, the gold standard surgical treatment for BPH consisted of open prostatectomy (OP), until the introduction of the transurethral resection of the prostate (TURP). TURP was shown to be an effective alternative to OP for prostates between 30 mL and 80 mL. 4 One clinical concern regardingTURP is thewell-known risk of TUR- syndrome syndrome, which can lead to fatal morbidity and has a prevalence of 1.1% of all TURPs. 5 TURP also has a significant postoperative bleeding risk, especially for anticoagulated patients, and has limited utility for large prostates > 80 mL. 6 With the continuous aging of the general population and the increased prevalence