Safety and efficacy using a low-powered holmium laser for enucleation of the prostate (HoLEP): 12-month results from a prospective low-power HoLEP series

摘要

Abstract Purpose To analyze the 12-month outcomes of low-powered holmium laser enucleation of the prostate (LP-HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). Methods A total of 54 patients with symptomatic BPO were treated with LP-HoLEP. All patients were treated by two experienced LP-HoLEP surgeons. A 50-W Ho:YAG laser was used at 39.6-W (2.2?J, 18?Hz). All patients were assessed preoperatively by International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post-void residual urine (PVR), PSA, and whole prostate volume measurement by transrectal ultrasound. The patients were reassessed at 1-, 6-, and 12-month follow-up. The complications were classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). Results The median age was 72.5 (67–77.25) years and the median preoperative prostate volume 74.5 (45–110) ml. 12 (22.2%) patients were treated with ongoing anticoagulant treatment. The median operative time was 65 (41–81)?min and the enucleation efficiency 1.11 (0.82–1.79)?g/min, respectively. Clavien 1 (11.1%), Clavien 2 (3.7%), Clavien 3a (3.7%), and Clavien 3b (5.5%) complications occurred. At 6-month follow-up, median prostate volume (74.5 vs. 15.5?ml) and PSA (4.03 vs. 0.54?μg/l) had improved significantly compared to baseline ( p ?≤?0.009). At 12-month follow-up, Qmax (12 vs. 29.3?ml/s), PVR (155 vs. 11.15?ml), IPSS (22 vs. 6) and QoL (5 vs. 1) had improved significantly ( p ? Conclusions LP-HoLEP is technically feasible, safe and effective for the treatment of symptomatic BPO. For experienced surgeons, power is less relevant than technique.