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Objective: To evaluate outcomes of Holmium laser enucleation of the prostate (HoLEP) in individuals presenting with obstructive-uropathy (OU) attributable to bladder outlet obstruction (BOO). Methods: We performed a retrospective review of patients who underwent HoLEP from August 2017 to January 2023 at our institution. We identified patients with preoperative OU defined by presence of chronic hydronephrosis suggestive of BOO and conducted a matched-pair analysis (1:2) with patients undergoing HoLEP without OU. Patients' demographic, perioperative and postoperative voiding parameters, serum creatinine level, and complications were analyzed up to one-year of follow-up. Results: Preoperative OU was present in 42 patients. Demographic and preoperative parameters were comparable except median preoperative creatinine (1.245 vs. 1.065 ng/ml, p < 0.001) and catheterization rates (76.2% vs. 25%, p < 0.001) were higher in the OU group. The mean duration of postoperative catheterization was longer in the OU group (3.83 vs. 2.26 days, p = 0.048). Two patients in the OU group developed postoperative acute kidney injury. There was no difference in the rate of postoperative complications, improvement in International Prostate Symptom Score and maximum urinary flow amongst both groups except a higher post-void residual volume at 3- and 12-months (p = 0.001 and p = 0.037, respectively) in OU patients. Patients noted significant improvement in serum creatinine level at 6–12 weeks postoperatively from peak baseline level (P = 0.002). Conclusion: HoLEP is effective and safe in patients with OU suggestive of BOO, though they are at higher risk of postoperative acute kidney injury. [ABSTRACT FROM AUTHOR]

Background: Until recently, Holmium laser enucleation of the prostate (HoLEP) utilisation has been limited despite its perceived benefits over alternative surgical and minimally invasive benign prostatic hyperplasia (BPH) treatments. Objective: The purpose of this review is to highlight our experience with recent advances in laser and morcellator technologies that have made it easier for urologists to consistently offer HoLEP as a safe, efficient, and effective in an ambulatory (day surgery) setting. Methods: Our narrative review focused on contemporary studies published within the last five years. Conclusions: Technological advances coupled with increasing availability of training opportunities has and will continue to improve patients' accessibility to the gold standard in BPH surgical treatment. Furthermore, we will describe refinements in laser enucleation techniques that have improved procedural efficiencies, rates of temporary post-operative urinary incontinence, and preservation of sexual function. The effects of technical modifications on functional and durability outcomes are to be seen in further prospective studies. Level of Evidence: Level 7 (Expert Opinion) [ABSTRACT FROM AUTHOR]

Introduction: Aims of the study were to investigate the related factors of urinary incontinence after transurethral holmium laser enucleation of the prostate (HoLEP) and to provide guidance for clinical urinary control of HoLEP. Methods: The clinical data of 548 patients who underwent HoLEP were retrospectively analyzed. The patients were followed up for the occurrence of urinary incontinence in the short term (2 weeks), medium term (3 months), and long term (6 months) after HoLEP. Results: Among the 548 benign prostatic hyperplasia patients, 79 cases (14.42%) had urinary incontinence at 2 weeks, 19 cases (3.47%) at 3 months, and 2 cases (0.36%) at 6 months after surgery. Logistic regression analysis showed that age, prostate volume, diabetes mellitus, operation time, prostate tissue weight, and histological prostatitis were risk factors for recent urinary incontinence (p < 0.05). Age, diabetes, and operation time were risk factors for mid-term urinary incontinence (p < 0.05). The incidence of long-term urinary incontinence was low and no risk factor analysis was performed. Conclusions: For good urinary control after HoLEP, in addition to surgery-related factors such as surgical skills, proficiency, and precise anatomy, patients' risk factors should also be paid attention to in order to improve postoperative urinary control more effectively and reduce the incidence of urinary incontinence. [ABSTRACT FROM AUTHOR]

Abstract Background Although holmium laser enucleation (HoLEP) is considered a size‐independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post‐operative and short‐term efficacy of PAE and HoLEP. Methods PubMed, Cochrane Library and EMBASE databases were searched. Network meta‐analysis was performed following PRISMA‐N‐guidelines. Post‐operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post‐void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared. Results Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: −2.21: 95%CI: (−10.20, 5.78), favouring PAE], QoL score improvement [WMD: −0.22:95%CI: (−1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (−59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1‐year follow‐up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (−1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (−1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (−32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (−2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP‐OR: 0.68, 95%CI: (0.25, 1.37)]. Conclusion HoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long‐term outcome of PAE are needed to establish the durability of early outcomes after PAE.

Objective: To preoperative factors that could predict the persisting storage symptoms after Holmium laser enucleation of the prostate (HoLEP). Methods: Medical records of 257 patients who underwent HoLEP between December 2014 and January 2021 were reviewed. Participants with a follow‐up period exceeding 6 months were included. Preoperative data, including International Prostate Symptom Score (IPSS), uroflowmetry, prostate size, and prostate‐specific antigen, were collected. All participants underwent a preoperative urodynamic study. The correlation between perioperative variables and postoperative medication therapy (antimuscarinics or beta‐3 agonists) was assessed. Results: Out of 257 participants in the study, 46 (18.6%) were allocated to the medication group, of which 25 (54.3%) initiated medication therapy postoperatively. The medication group showed worse postoperative IPSS storage symptom score and quality of life score compared to the medication‐free group (p = 0.048 and p = 0.002, respectively), but no significant differences were observed in complications or operative variables. In the de‐novo medication group, patients had lower preoperative Qmax, larger prostate volume, and smaller maximum cystometric capacity (MCC) compared to the persisting medication group (p = 0.020, p = 0.009, and p = 0.008, respectively). Overactive bladder (OAB) history, terminal detrusor overactivity (DO), and IPSS urgency item were identified as possible predictive factors for post‐HoLEP medication use. Conclusions: Preoperative factors such as OAB history, terminal DO, and IPSS urgency item may predict the need for post‐HoLEP medication therapy. Further follow‐up studies are warranted to understand the characteristics of the de‐novo medication group due to the significant discomfort it can cause to patients. [ABSTRACT FROM AUTHOR]

Introduction: Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hyperplasia (BPH) relative to other interventions. Unfortunately, the adoption of HoLEP has remained relatively low in Medicare and the National Surgical Quality Improvement Program populations. HoLEPs role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016 to 2019. Materials and Methods: The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time points for trends. Chi-squared tests and two-sample t-tests were completed for categorical and continuous variables, respectively. Results: The total number of ambulatory BPH surgeries fell 20% between 2016 (n = 124,538) and 2019 (n = 100,593). In 2016, HoLEP lagged behind photoselective vaporization of the prostate (PVP) and transurethral resection of prostate (TURP) with 4.7% of surgeries but rose to the second most common procedure in 2019 with 8.3% of total surgeries. TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By U.S. census region, more HoLEPs were carried out in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019). Conclusions: Overall, HoLEP uptake is increasing. HoLEP has replaced greenlight PVP as the second most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the number of surgeries. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series. Methods: One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated. Among them, 76 were eligible for this study and underwent reconstructive surgery. Preoperative and postoperative assessments were done with symptom scores, uroflowmetry, ultrasound for post-void residue, and urethrogram. Any intervention during follow-up was classed as a failure. The recurrence and 95% confidence interval for recurrence percentage were calculated. Results: The following five categories of patients were identified: Bulbo-membranous (33 [43.4%]), navicular fossa (21 [27.6%]), penile/peno-bulbar (8 [10.5%]), bladder neck stenosis (6 [7.9%]), and multiple locations (8 [10.5%]). The average age was 69 years (range: 60–84 years). Overall average symptom score, flow rate, and post-void residue changed from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. The average follow-up was 34 months (range: 12–58 months). Overall recurrence and complication rates were 10.5% and 9.2%, respectively. The recurrence in each category was seen in 3, 1, 2, 1, and 1 patient, respectively. Overall 95% confidence interval for recurrence percentage was 4.66–19.69. Conclusion: Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH. The bulbo-membranous strictures need continence preserving approach. Navicular fossa strictures require minimally invasive and cosmetic consideration. Peno-bulbar strictures require judicious use of grafts and flaps. Bladder neck stenosis in this cohort could be treated with endoscopic measures. Multiple locations need treatment based on their sites in single-stage as far as possible.

Objective: To compare the clinical efficacy and safety of holmium laser enucleation of the prostate (HoLEP) with bipolar plasmakinetic enucleation of the prostate (BPEP) in the surgical management of obstructive benign prostatic hyperplasia (BPH) at midterm (minimum 3 years) follow-up. Patients and Methods: Between June 2016 and January 2018, 181 patients who had bothersome lower urinary tract symptoms or refractory retention of urine due to obstructive BPH (prostate 32–128 g) were randomized to undergo either HoLEP or BPEP using the en bloc technique. Patient's age, associated comorbidities, baseline International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR) urine, and quality of life (QoL) scores were comparable in both groups. From each group, 86 patients who completed regular follow-up for 36 months were analyzed. Results: The mean preoperative prostate volume was comparable in both groups (HoLEP group 61.09 ± 28.25 and BPEP group 62.66 ± 27.37 g). The HoLEP group showed a significantly better enucleation time (27.87 ± 13.18 minutes vs 38.37 ± 14.55 minutes), operative time (30.91 ± 14.82 minutes vs 41.63 ± 16.19 minutes), and enucleation efficiency (1.69 ± 0.28 vs 1.28 ± 0.06 g/min), with a lesser drop in hemoglobin (0.46 ± 0.23 vs 0.87 ± 0.26 g/dL). Bladder irrigation time, catheterization time, hospital stay, and sodium drop were comparable in both groups. One patient in the BPEP group needed clot evacuation. Both groups showed a significant reduction in IPSS, improvement in Qmax, reduction in PVR, and improved QoL scores at 3 months, which was maintained till 36 months. At the 3-year follow-up, two patients in each group needed reintervention for bladder neck contracture. Conclusions: HoLEP and BPEP provide comparable safety and efficacy in the treatment of bladder outlet obstruction due to BPH at the immediate and midterm (3–5 years) follow-up. HoLEP has an advantage of being faster with lesser perioperative morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications. Methods: All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed®, Scopus®, and Web of Science™ databases from January 1, 1998, to June 1, 2020. Results: Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0–7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%). Conclusions: HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1–2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique. [ABSTRACT FROM AUTHOR]

The purpose of the study was to study the feasibility of holmium laser enucleation of prostate (HoLEP) with en bloc and urethral mucosal flap sparing technique in treating benign prostatic hyperplasia (BPH) patients and to evaluate the influence of this modified technique on urinary function. A cohort of 188 BPH patients underwent HoLEP from June 2017 to October 2019. Among them, 92 patients underwent conventional en bloc HoLEP and the other 96 patients underwent HoLEP with en bloc and urethral mucosal flap sparing techniques. The basic characteristics, the volume of the prostate, urodynamic data, and perioperative parameters were recorded for comparison. The outcome parameters include international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), post-voiding residual (PVR), quality of life score (QoL), and incidence of de novo stress urinary incontinence (SUI). The basic characteristics were equivalent in both groups. All HoLEP procedures were smoothly carried out. The perioperative complications were low and did not show a significant difference. The follow-up period was 12 months or longer. IPSS, Qmax, QoL, and PVR were improved postoperation in both groups. There was no statistical difference in the parameters between the two groups. When considering a postoperative SUI, the occurrence of short-term and long-term SUI in the modified HoLEP group was significantly less than those in the conventional HoLEP group (p < 0.05). In summary, HoLEP by using en bloc and urethral mucosal flap sparing technique is a safe and effective treatment for BPH patients, especially in preventing postoperative SUI. [ABSTRACT FROM AUTHOR]

Purpose We compared success rates of 3 surgical techniques (holmium laser enucleation of the prostate [HoLEP], transurethral resection of the prostate [TURP], and photoselective laser vaporization prostatectomy [PVP]) for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success. Methods A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, postvoid residual urine, and IPSS/QoL index were measured 6 months postoperatively. Surgical success was defined based on IPSS, maximum flow rate, and QoL index and predictive factors were identified using multiple logistic regression analyses. Results Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥50 mL and bladder outlet obstruction index (BOOI) ≥40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated. Conclusions Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥50 mL and BOOI ≥40 were independent predictive factors for the success of HoLEP but not of TURP.

Objective: The primary purpose was to compare the completeness of adenomectomy and zonal anatomy of prostate on magnetic resonance imaging prostate after transurethral resection of prostate and Holmium enucleation of prostate. The secondary purpose was to investigate the relationship between preoperative total prostate volume and postoperative transition zone and peripheral zone volume after both procedures. Material and methods: A retrospective review of all patients who underwent transurethral resection of prostate or Holmium enucleation of prostate over 3 years (2017-2020) and had at least 1 postoperative magnetic resonance imaging prostate was performed. Volume estimations of the prostate and individual zones were performed, and statistical comparisons were made to evaluate morphometric changes between the 2 procedures. Results: A total of 9 patients (mean age, 71.8 years) underwent transurethral resection of prostate and 12 patients (mean age, 66.9 years) underwent Holmium enucleation of prostate. The median pre-operative prostate volume in the Holmium enucleation of prostate group was higher than the transurethral resection of prostate group (101.5 g vs. 62 g; P = .102). However, there was a significant difference in the resected tissue weight favoring Holmium enucleation of prostate over transurethral resection of prostate (P value = .004). The postoperative transition zone and peripheral zone volume as calculated by magnetic resonance imaging remained relatively constant in both procedures. The peripheral zone volume on postoperative magnetic resonance imaging was found to be independent of transition zone volume even for very large-sized prostates. Conclusion: A well-performed transurethral resection of prostate or Holmium enucleation of prostate can nearly completely eliminate the transition zone volume, irrespective of the size of the prostate as confirmed by magnetic resonance imaging prostate. Additionally, the peripheral zone volume is consistent across the entire spectrum of the prostate size. [ABSTRACT FROM AUTHOR]

Introduction: The number of social media users is gradually increasing, and they are spending their time gathering a lot of useful information for themselves. Here, we analysed the quality of Holmium Laser Enucleation of Prostate (HoLEP) surgery videos on YouTube. Aim: To assess the quality of the most viewed HoLEP videos on YouTube using validated questionnaires and scoring systems developed to evaluate the significant features. Material and methods: The most viewed 98 videos were included in this study by the search for 'Holep' keyword on YouTube. The Journal of American Medical Association Benchmark Score (JAMAS) and Global Quality Score (GQS) were used to analyse the videos after the validated HoLEP Scoring System Score (HSSS) was performed by 3 HoLEP trained surgeons to evaluate the technical quality of videos. Results: The videos including surgical technique (76.5%) and uploaded by urologists (63.3%) constituted the majority of videos. The median of JAMAS, GQS, and HSSS were 1 (0-3), 2 (0-4), and 1.5 (0-11), respectively. The mean GQS and JAMAS of videos uploaded by academic centres was higher than those uploaded by commercial centres and urologists (p = 0.01; p = 0.01, respectively). The mean HSSS was lower in the videos uploaded in the last 5 years, while JAMAS was higher (p = 0.03, p = 0.005, respectively). The mean GQS and HSSS of videos with higher likes were found statistically significantly higher (p = 0.01; p = 0.02, respectively). Conclusions: HoLEP videos on YouTube are not adequate to obtain proper information about the surgery. Videos uploaded by academic centres and in recent years provide more valid information for patients and urologists. To increase the value of information, online materials need to be checked, for patients to access accurate, reliable, and appropriate healthcare information. [ABSTRACT FROM AUTHOR]

Introduction: Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP), both are considered standard endosurgical treatment of benign prostatic hyperplasia (BPH). Many studies have evaluated changes in sexual function following treatment of BPH. However, data are sparse on comparative study between the two standard options of the treatment of BPH. Aim: The aim of this study was to compare changes in sexual function following HoLEP versus TURP using the International Index of Erectile Function-15 (IIEF-15) questionnaire. Materials and Methods: A prospective study carried out for 4 years from May 2013 to April 2017. All patients with bothersome lower urinary tract symptoms due to BPH, who got admitted to the hospital for surgical management, were enrolled for the study and they underwent either HoLEP or TURP. Postoperatively, they were followed for 6 months at 1-, 3-, and 6-month interval. Main Outcome Measures: Statistical testing was conducted with the Statistical Package for the Social Science system version 17.0. Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as absolute numbers and percentage. The comparison of normally distributed continuous variables between the groups was performed using Student's t- test. For within the groups, paired t-test was used at 1 month, 3 months, and 6 months from the baseline. Results: All the five domains of sexual function based on the IIEF-15 questionnaire remained significantly low at 6-month postsurgery in both the groups. Conclusions: By comparing the changes in sexual function between HoLEP and TURP group at the end of our study (6 months), we found no difference between the groups with regard to erectile function or overall sexual function as assessed by total IIEF-15 score.

Objectives: To compare the safety and efficacy of holmium laser enucleation of prostate (HoLEP) vs bipolar plasmakinetic resection of prostate (BPRP) in the management of large-sized (≥75 g) benign prostatic hyperplasia (BPH). Methods: This randomized-controlled trial recruited 145 symptomatic BPH patients who had failed medical management, and who had undergone either HoLEP (Versa pulse® 100 W; n = 73) or BPRP (AUTOCON® II 400 ESU; n = 72). Both groups were compared using the Mann–Whitney, chi-square, Student-t, or Fisher exact tests as appropriate. Preoperative vs postoperative findings (24 months) were compared using paired t-test or Wilcoxon signed-rank test. Results: The two groups were comparable for most preoperative findings including prostate size (p = 0.629), although HoLEP included more patients on anticoagulants (p = 0.001). HoLEP was associated with significantly less operative duration (p < 0.001), hemoglobin loss (p < 0.001), catheterization duration (p = 0.009), and hospital stay (p < 0.001). There was no significant difference in total complications (p = 0.291) and each separate complication. Blood transfusion was reported only with BPRP (p = 0.058). At 24 months of follow-up, there was significant improvement in all the parameters in each group (International Prostate Symptom Score [IPSS], maximum urinary flow rate [Qmax], quality of life [QoL], and postvoid residual urine [PVRU]; p < 0.001). There was no significant difference between both groups in postoperative IPSS (p = 0.08), Qmax (p = 0.051), QoL (p = 0.057), or PVRU (p = 0.069). There was significantly better percentage improvement of both IPSS (p = 0.006) and QoL (p = 0.025) in HoLEP. HoLEP and smaller removed (resected or enucleated) tissues were associated with a reduction in the primary outcomes (hemoglobin loss and operative duration) in logistic regression analysis. Conclusion: HoLEP showed better safety profile with significantly less operative duration, hemoglobin loss, hospital stay, and catheterization duration. Although both procedures were effective, HoLEP showed significantly better percentage improvement of both IPSS and QoL. ClinicalTrials.gov Identifier: NCT04143399. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) for treating urinary retention in patients with advanced prostate cancer. Thirty-eight cases of advanced prostate cancer with urinary retention were enrolled in this retrospective study. All the 38 patients were treated with CAB as a basis. Among them, 21 cases chose HoLEP additionally (HoLEP group). Seventeen cases stuck to CAB alone (CAB group). Serum PSA level, International Prostate Symptom Score (IPSS), quality of life score (QoLs), maximal flow rate (Qmax), and post-void residual volume (PVR) at 3, 6, 12, and 18 months after treatment were comparatively analyzed. The perioperative and postoperative parameters of HoLEP were assessed. Both groups demonstrated significant improvement in IPSS, QoLs, Qmax, and PVR during follow-up. But these parameters of HoLEP group improved more rapidly, significantly, and durably than CAB group. No serious complications were observed during and after HoLEP. PSA level of patients in both groups declined dramatically after surgery. But PSA in HoLEP group showed more dramatic and continuous drop. Besides, 1 of 21 patients in HoLEP group transferred into castration-resistant prostate cancer (CRPC) at 18th month of follow-up. While in CAB group, 5 of 17 patients developed into CRPC at 12th month of follow-up (P = 0.02 < 0.05). HoLEP was minimally invasive, safe, and effective, and could serve as a palliative approach to rapidly restore the patients' urine and play a cytoreductive role in advanced PCa to improve the oncological prognosis. [ABSTRACT FROM AUTHOR]

Aim: Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g. Materials and Methods: This prospective randomized study includes 164 patients. Inclusion criteria were age 60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery. Results: Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up. Conclusion: HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria.

Introduction: Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP), both are considered standard endosurgical treatment of benign prostatic hyperplasia (BPH). Many studies have evaluated changes in sexual function following treatment of BPH. However, data are sparse on comparative study between the two standard options of the treatment of BPH. Aim: The aim of this study was to compare changes in sexual function following HoLEP versus TURP using the International Index of Erectile Function-15 (IIEF-15) questionnaire. Materials and Methods: A prospective study carried out for 4 years from May 2013 to April 2017. All patients with bothersome lower urinary tract symptoms due to BPH, who got admitted to the hospital for surgical management, were enrolled for the study and they underwent either HoLEP or TURP. Postoperatively, they were followed for 6 months at 1-, 3-, and 6-month interval. Main Outcome Measures: Statistical testing was conducted with the Statistical Package for the Social Science system version 17.0. Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as absolute numbers and percentage. The comparison of normally distributed continuous variables between the groups was performed using Student's t- test. For within the groups, paired t-test was used at 1 month, 3 months, and 6 months from the baseline. Results: All the five domains of sexual function based on the IIEF-15 questionnaire remained significantly low at 6-month postsurgery in both the groups. Conclusions: By comparing the changes in sexual function between HoLEP and TURP group at the end of our study (6 months), we found no difference between the groups with regard to erectile function or overall sexual function as assessed by total IIEF-15 score. [ABSTRACT FROM AUTHOR]

Aims: To examine how morphological differences in intravesical prostatic protrusion (IPP) predict outcome of Holmium laser enucleation of prostate (HoLEP) treatment. Methods: We analyzed 173 patients who had undergone HoLEP in our hospital. The protrusion shape was evaluated by outpatient preoperative flexible cystoscopy and classified into five groups: A, no protrusion; B, middle lobe only; C, unilateral lobe only; D, bilateral lobes; and E, B + C or B + D. Paired‐match analysis that adjusted for preoperative International Prostate Symptom Score (IPSS) voiding/storage subscores and IPP was performed between the group with middle lobe protrusion (B + E) and the group without it (C + D). Results: Type A prostate shape was found in 23 patients, type B in 14, type C in 31, type D in 71, and type E in 34. Groups with middle lobe protrusion (B and E) had better changes in the total IPSS (P < 0.05) and the IPSS storage subscore (P < 0.01). Pair matching identified 37 patients each with or without middle lobe protrusion. The group with middle lobe protrusion had significantly more improved total IPSS (−17.5 ± 7.5 vs −13.5 ± 8.3, P < 0.05) and IPSS storage subscore (−6.9 ± 3.4 vs −4.8 ± 3.3, P < 0.05) than did those without middle lobe protrusion. Conclusions: Patients with middle lobe protrusion had greater IPSS improvement after HoLEP than those having comparable‐length IPP but without middle lobe protrusion. IPP is not always the same shape and should be clinically divided into at least two groups. [ABSTRACT FROM AUTHOR]

Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (>60 g). For extremely large glands (>150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient′s comorbidities and surgeon′s expertise.

Lasers have come a long way in the management of benign prostatic hyperplasia. Over last nearly two decades, various different lasers have been utilized for prostatectomy. Neodymium: yttrium-aluminum-garnet laser that started this journey, is no longer used for prostatectomy. Holmium laser can achieve transurethral enucleation of the prostatic adenoma producing a fossa that can be compared with the fossa after Freyer′s prostatectomy. Green light laser has a short learning curve, is nearly blood-less with good immediate results. Thulium laser is a faster cutting laser while diode laser is a portable laser device. Often laser prostatectomy is considered as a replacement for the standard transurethral resection of prostate (TURP). To be comparable, laser should reduce or avoid the immediate and long-term complications of TURP, especially bleeding and need for blood transfusion. It should also be safe in the ever increasing patient population on antiplatelet and anticoagulant drugs. We need to take stock of the situation and identify, which among the present day lasers has stood the test of time. A review of the literature was performed to see if any of these lasers could be called the "best laser for prostatectomy in 2013."

Aim: Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g. Materials and Methods: This prospective randomized study includes 164 patients. Inclusion criteria were age <75 years after failed or poor response to medical therapy, prostatic size >60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery. Results: Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up. Conclusion: HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria. [ABSTRACT FROM AUTHOR]

Background: Holmium laser enucleation of the prostate (HoLEP) is a proven surgical technique for the treatment of benign prostatic hyperplasia (BPH). However, its challenging learning curve prevents its widespread adoption by urologists. The aim of this study was to analyse the learning curve of HoLEP and to determine the factors accelerating it., Methods: This was a retrospective, monocentric cohort study of the first 60 cases of HoLEP performed by three operators. The primary outcome measure was operative efficiency, defined as the ratio of preoperative prostate volume estimated by trans-abdominal ultrasound (TAUS)to total surgical time in minutes. The studied learning curve parameters included the number of previously performed cases (NPPCs) and monthly case density (CD) (number of monthly performed cases before the studied one)., Results: Overall, 180 patients with a mean age of 71 (±9) years and a mean prostate volume (g) of 80.4 (±41) were included. The mean operative efficiency in the population was 0.74 (±0.37) g/min. Operative efficiency was increased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 0.66 (±0.27) g/min vs. CD ≥3: 0.79 (±0.43) g/min; P=0.012). At 3months, 46 patients (29%) developed stress urinary incontinence (SUI). Early SUI was significantly decreased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 37%, (n=26) vs CD ≥3: 22%, (n=20); P=0.045)., Conclusions: A high frequency HoLEP procedures, set as one case per week, appeared to accelerate learning curves by improving operative efficiency. A high CD was also associated with reduced rates of early SUI., Level of Proof: 5., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Lasers have come a long way in the management of benign prostatic hyperplasia. Over last nearly two decades, various different lasers have been utilized for prostatectomy. Neodymium: yttrium-aluminum-garnet laser that started this journey, is no longer used for prostatectomy. Holmium laser can achieve transurethral enucleation of the prostatic adenoma producing a fossa that can be compared with the fossa after Freyer's prostatectomy. Green light laser has a short learning curve, is nearly blood-less with good immediate results. Thulium laser is a faster cutting laser while diode laser is a portable laser device. Often laser prostatectomy is considered as a replacement for the standard transurethral resection of prostate (TURP). To be comparable, laser should reduce or avoid the immediate and long-term complications of TURP, especially bleeding and need for blood transfusion. It should also be safe in the ever increasing patient population on antiplatelet and anticoagulant drugs. We need to take stock of the situation and identify, which among the present day lasers has stood the test of time. A review of the literature was performed to see if any of these lasers could be called the "best laser for prostatectomy in 2013." [ABSTRACT FROM AUTHOR]

Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (>60 g). For extremely large glands (>150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient's comorbidities and surgeon's expertise. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Holmium laser enucleation of prostate (HoLEP) represents one of the most studied surgical techniques for benign prostatic hyperplasia (BPH). Its efficacy in symptom relief has been widely depicted. However, few evidence is available regarding the possible predictors of symptom recurrence. We aimed to evaluate long-term outcomes, symptom recurrence rate, and predictors in patients that underwent HoLEP., Materials and Methods: We retrospectively analyzed data from patients that consecutively underwent HoLEP for BPH from 2012 to 2015 at two tertiary referral centers. Functional outcomes were evaluated by uroflowmetry parameters and International Prostate Symptom Score (IPSS) questionnaire administration at follow-up visits at 12, 24, and 60 months. The primary outcome was the symptomatic patients' rate presenting lower urinary tract symptoms (LUTS) after 60 months from surgery, defined as in case of one or more of the following: IPSS more than 7, post voidal residue (PVR) more than 20 ml, need for medical therapy for LUTS or redo surgery for bladder outlet obstruction. Multivariable logistic regression analyses evaluated predictors for being symptomatic at follow-up. Covariates consisted of: preoperative peak flow rate (PFR), PVR, and IPSS, prostate volume, age (all as continuous), and surgical technique., Results: A total of 567 patients were available for our analyses. Median prostate volume was 80cc, with a median PFR of 8 ml/s and median PVR of 100cc. One hundred and twenty-five (22%) patients were found to be symptomatic at follow-up. Redo surgery was needed for 25 (4.4%) patients. After adjusting for possible confounders, an increase in preoperative PVR (odds ratio [OR] 1.005) and IPSS (OR 1.12) resulted as independent predictors for symptom recurrence (all p < 0.001)., Conclusions: HoLEP can provide durable symptom relief regardless of the chosen technique. Patients with an important preoperative symptom burden or a high PVR should be carefully counseled on the risk of symptom recurrence., (© 2021 Wiley Periodicals LLC.)

Background: This study aimed to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) by using en-bloc and bladder neck preservation technique on benign prostatic hyperplasia (BPH) and assess the influence of this procedure on urinary and sexual functional outcomes., Methods: A total of 704 patients with BPH undergoing HoLEP were retrospectively analysed. Amongst them, 213 who met the sexual function assessment criteria were further assessed the influence of the technique on sexual functional outcomes., Results: The mean operative time, resected prostate weight and mean estimated blood loss were 69.3±14.8 min, 53.4±17.6 g and 62.1±23.7 mL, respectively. The mean duration of catheterization after surgery and mean hospital stay were 2.1±1 and 5.4±3.6 days, respectively. The post-void residual volume, maximum urinary flow rate, international prostate symptom score and quality of life score were all significantly improved postoperation (P<0.05). Amongst the 213 patients with normal antegrade ejaculation before surgery, postoperative international index of erectile function scores slightly improved, although the difference was insignificant (P>0.05). The difference in the Erection Hardness Grading Scale before and after surgery was statistically insignificant (P>0.05). A total of 25 (11.7%) patients had retrograde ejaculation after surgery., Conclusions: HoLEP by an en-bloc and bladder neck preservation technique can obtain good functional outcome with small injury and high efficiency, especially for patients who need to preserve normal sexual function and anterograde ejaculation., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-20-852). The authors declare that they have no conflict of interest., (2021 Translational Andrology and Urology. All rights reserved.)

Résumé Introduction L’énucléation de la prostate au laser holmium (HoLEP) est une technique mini-invasive, indépendante de la taille de la prostate pour l’hyperplasie bénigne de la prostate avec d’excellents résultats chirurgicaux à long terme. Le but de cet article est de décrire les détails de la technique étape par étape. Méthode Description de toutes les étapes de la procédure HoLEP en listant tous les aspects pratiques basée sur l’expérience personnelle de l’auteur et documentée à partir de l’analyse de la littérature. Résultats Les trucs et astuces concernant la préparation préopératoire, l’énucléation des lobes médian et latéraux, l’hémostase, la morcellation, les suites opératoires sont abordés point par point. Conclusion La technique HoLEP est devenue une alternative à la résection transurétrale de prostate conventionnelle ou à l’adénomectomie par voie haute au vu de son efficacité et de sa faible morbidité. Le respect et la compréhension des différentes étapes de la procédure sont importants pour optimiser la courbe d’apprentissage. Summary Introduction Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive technique, independent of the size of the prostate for benign prostatic hyperplasia with excellent surgical results in the long term. The purpose of this article is to describe the details of the technique step by step. Method Description of all steps of the HoLEP procedure by listing all the practical aspects based on personal experience of the author and documented review of the literature. Results Tips and tricks on the preoperative preparation, medial and lateral lobes enucleation, hemostasis, morcellation, postoperative outcomes are discussed point by point. Conclusion HoLEP technique has become an alternative to conventional transurethral resection of prostate or prostatectomy way to high for its efficiency and its low morbidity. Respect and understanding of the different steps of the procedure are important to optimize the learning curve. [ABSTRACT FROM AUTHOR]

Purpose: We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques., Materials and Methods: A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study., Results: From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002)., Conclusions: Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)