Evaluation Of The Clinical Effect Of Transurethral Holmium Laser Enucleation Of Prostate For Benign Prostatic Hyperplasia

PART ONE:Holmium laser enucleation of the prostate for extremely enlarged benign prostate hyperplasia after prostatic arterial embolization:Preliminary results were assessed by imaging study.The patient was kept under closed-continuous irrigation for the first 24 h after HoLEP.The catheter was removed at 3 days postoperation.Patients who could not urinate after removing the catheter were recatheterized and subjected to a bladder training program for 1 week before removing the catheter for the second time.All the patients were then instructed to visit the hospital 6 months after the operation to undergo a follow-up procedure with an assistant.Objective:To report the initial experience with holmium laser enucleation of the prostate(HoLEP)for extremely enlarged prostates in benign prostate hyperplasia(BPH)after prostatic arterial embolization(PAE),and retrospectively estimate the efficacy and safety of this novel technique.Patients and methods:A total of 24 BPH patients who underwent PAE and subsequent HoLEP from February 2013 to March 2015 in The First Affiliated Hospital of Nanjing Medical University were included in this retrospective study.The age range was 53-82 years with a mean age of 72 ± 6.6 years.All these patients presented with moderate-to-severe LUTS and refractory to medical treatment and/or had indwelling catheter more than once.None of these patients manifested absolute contraindications to the proposed surgery.Bladder outlet obstruction(BOO)and favorable bladder contractility were proved by urodynamic studies.The PAE procedure was performed under local anesthesia at the supine position with polyvinyl alcohol spherical particles and gelatin sponge particles.HoLEP was performed 3 months after PAE by the "en-bloc" enucleation technique.Clinical data of all patients before and 6 months after the procedure were collected.International Prostate Symptom Score(IPSS),maximal flow rate(Qmax),prostatic specific antigen(PSA)level,transrectal ultrasound examination,or magnetic resonance(MR)images were also recorded.The prostate volume and postvoid residual volume(PVR)Results:PAE and HoLEP were technically successful in all 24 patients.The mean prostate volume was 219 ± 38 mL;mean total operative time and enucleation time for HoLEP were 117.8± 21.9 and 83.5 ± 15.4 min,respectively;and mean resected prostate weight was 118.3 ± 20.7 g.No transurethral resection of the prostate syndrome was observed during and after HoLEP.The estimated blood loss during HoLEP was 72.1± 33.7 mL,and no case required transfusion.The catheter was removed at 3 days postoperation.Six patients could not urinate after removing the catheter and were recatheterized and subjected to a bladder training program for 1 week;thereafter,these patients got normal urination when the catheter was removed for the second time.International Prostate Symptom Score and postvoid residual volume significantly decreased(24.1±2.84 vs 13.5±3.39,P<0.001;107.1±40.8 vs 21.8±16.8,P<0.001,respectively),maximal flow rate significantly increased(6.25±1.42 vs 17.63±16.56,P<0.001),and prostatic specific antigen level also decreased after the procedure(9.29±2.28 vs 4.99±1.35,P<0.001).Conclusions:After the initial PAE procedure,HoLEP using the en-bloc technique can be performed safely and efficiently in patients with extremely enlarged prostates.PART TWO:Holmium laser enucleation of prostate for patients in acuteurinaryretention due to benign prostate hyperplasia:Efficacy and safetyObjective:To evaluate the effectiveness and safety of the holmium laser enucleation of prostate(HoLEP)for patients with benign prostate hyperplasia(BPH)in the setting of acute urinary retention(AUR).Patients and methods:We retrospectively compared BPH patients with AUR(n=88)and without AUR(n=148)treated with HoLEP.Before HoLEP,general information,size of the prostate,urodynamic parameters were recoeded.Major intraoperative parameters were recorded and compared.The patients were followed up and the outcome were recorded and analysed including symptom score,quality of life score,Qmax,and post-voiding residual(PVR).Results:In both group,the preoperative parameters were equivalent except for the white blood cell in urinalysis.All the HoLEP procedures were smoothly carried out.The intr-and post-operative complications were low in both groups and no difference were detected.All the patients were followed up for at least 6 months.Symptom score,quality of life,Qmax and PVR were all improved in both groups.No statistical differences were obtained in these parameters between groups.Conclusion:HoLEP could be a safe and effective treatment for BPH patients either with or without AUR.The efficacy was immediate and sustained during the short-term follow-up session in both groups.