Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Amirreza Abedi; Mohammad Reza Razzaghi; Amirhossein Rahavian; Ebrahim Hazrati; Fereshte Aliakbari; Vahid Vahedisoraki; Farzad Allameh

doi:10.34172/jlms.2020.33

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

J Lasers Med Sci. 2020 Spring;11(2):197-203. doi: 10.34172/jlms.2020.33. Epub 2020 Mar 15.

Authors

Amirreza Abedi¹, Mohammad Reza Razzaghi², Amirhossein Rahavian¹, Ebrahim Hazrati³, Fereshte Aliakbari⁴, Vahid Vahedisoraki⁵, Farzad Allameh²

Affiliations

¹ Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ School of Medicine, 501 Hospital (Imam Reza), AJA University of Medical Sciences, Tehran, Iran.
⁴ Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

Keywords: HoLEP; Laser; Minimal invasive; Prostate hyperplasia; Prostate surgery; Transurethral resection of prostate.

Publication types

Review