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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

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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 < 0.001).

Conclusions

LP-HoLEP is technically feasible, safe and effective for the treatment of symptomatic BPO. For experienced surgeons, power is less relevant than technique.

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Authors and Affiliations

  1. Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany

    B. Becker, A. J. Gross & C. Netsch

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  1. B. Becker
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  2. A. J. Gross
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Contributions

BB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. BB: Project development, Data collection, Data analysis, Manuscript writing/editing. AJG: Project development, Manuscript writing/editing. CN: Project development, Data collection, Data analysis, Manuscript writing/editing

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Correspondence to B. Becker.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Becker, B., Gross, A.J. & Netsch, C. 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. World J Urol 36, 441–447 (2018). https://doi.org/10.1007/s00345-017-2159-5

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  • DOI: https://doi.org/10.1007/s00345-017-2159-5

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