Login to Access Video or Poster Abstract: MP27-06
Sources of Funding: None

Introduction

Holmium laser enucleation of the prostate (HOLEP) is an ideal option for very large prostate glands that would otherwise be managed by simple prostatectomy. However, a steep learning curve has limited widespread adoption of this procedure. Early in our experience we staged very large glands by removing the median lobe when necessary with enucleation of only one lateral lobe to reduce excessive OR times. These patients were followed to determine if a partial HOLEP adequately reduced obstructing voiding symptoms and whether additional procedures to complete the enucleation were necessary.

Methods

We performed a retrospective review of 84 patients with bladder outlet obstruction who underwent a HOLEP with a single surgeon between 1/2013-10/2016. We specifically evaluated whether the improved symptoms maintained over time or whether obstructive symptoms re-developed requiring another intervention.

Results

Median age was 72 years. Median size of prostate on transrectal ultrasound was 93gm (48-200gm). 14 patients underwent a partial HOLEP, and all were within the first 40 cases. Of these, 6 patients were content with their symptoms with significant improvement of uroflow parameters and IPSS scores (p<0.03) at last date of follow up. Eight patients of the 14 patients had persistent symptoms or developed new symptoms such that they required another intervention. One patient developed gross hematuria from the remaining lobe, one patient developed a bladder stone, and the remaining 6 complained of returning obstructive voiding symptoms requiring a completion resection.

Conclusions

While performing a partial HOLEP may maintain lower OR times and assist with the learning curve, the majority of patients will require another surgery within 2 years due to recurrent symptoms or complications such as bleeding and bladder stones._x000D_ A complete HOLEP should be performed whenever possible to optimize patient outcomes. _x000D_

Funding

None