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Holmium Laser Enucleation (holmium + laser_enucleation)
Selected AbstractsHolmium laser enucleation for large (greater than 100 mL) prostate glandsINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Janaka A Hettiarachchi Abstract Background: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands >,100 mL. Methods: Eighteen patients with preoperative prostate volumes >,100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. Results: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. Conclusions: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands >,100 mL. [source] Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literatureBJU INTERNATIONAL, Issue 1 2007Hemendra N. Shah OBJECTIVE To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. PATIENTS AND METHODS We analysed the patients' demographic, peri-operative and follow-up data, and the complications during and after surgery. RESULTS HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re-catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%). CONCLUSIONS There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient. [source] Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literatureBJU INTERNATIONAL, Issue 3 2007Hemendra N. Shah OBJECTIVE To report experience with holmium laser enucleation of the prostate (HoLEP) simultaneously with transurethral holmium laser cystolithotripsy (HLC) for managing bladder outlet obstruction (BOO) and associated vesical calculi; we also review previously reported cases of managing vesical calculi and associated BOO. PATIENTS AND METHODS The high-powered holmium laser is a very efficient multifunctional endourological instrument that effectively fragments calculi of all compositions and is capable of haemostatic cutting of tissue, resulting in minimal bleeding after prostatic resection. A prospective study was conducted from April 2003 that included 32 men who underwent simultaneous HoLEP with transurethral HLC at our institution. Demographic, laboratory, peri-operative and follow-up data were analysed. Complications during and after surgery were identified to assess the morbidity of procedure. RESULTS The mean (range) size of bladder calculi was 34.6 (12,70) mm and the preoperative weight of the prostate was 51.9 (11,172) g. Combined HoLEP with transurethral HLC was technically feasible in all patients, and all were stone-free after surgery. The mean operative duration was 97.7 (40,230) min, the weight of prostate tissue removed 34.6 (5,88) g, and the duration of catheterization and hospital stay 29.3 h and 34.8 h, respectively. Complications during and after surgery occurred in 12.5% and 15.6% of patients, respectively; all complication were minor and none caused any residual disability to the patient. No patient required a blood transfusion or developed clot retention. CONCLUSIONS Managing bladder stones and BOO with simultaneous transurethral HLC and HoLEP should be considered the treatment of choice for such cases. Stones of any size and composition, and prostates of practically any size can be treated endoscopically using the holmium laser, with acceptable morbidity once the technique is mastered. The review of previous reports suggested a need for a prospective study comparing endoscopic management of BOO and associated bladder stones, with medical management of BOO and extracorporeal shock wave lithotripsy/endoscopic lithotripsy for bladder stone. [source] Day-case holmium laser enucleation of the prostate for gland volumes of < 60 mL: early experienceBJU INTERNATIONAL, Issue 1 2003T.R.G. Larner OBJECTIVE To examine the safety and effectiveness of holmium laser enucleation of the prostate (HoLEP), as a day-case procedure for selected patients. PATIENTS AND METHODS Thirty-eight men underwent HoLEP as a day-case procedure; they were discharged with an indwelling catheter for 48 h with ,Hospital In The Home' nursing management. They were evaluated for symptomatic and flow rate improvements after 3 months. Morbidity, length of stay, the duration of catheterization and readmission rates were evaluated. RESULTS The objective symptom score and flow-rate improvements were equivalent to those previously published for transurethral resection of the prostate (TURP). There were five minor complications, three of which required readmission to hospital and one repeat surgery. The mean stay after surgery was 302 min. CONCLUSIONS Day-case HoLEP is a safe and effective treatment for symptomatic benign prostatic hyperplasia. The outcomes are equivalent to those from TURP. Whilst there were three re-admissions to hospital, two only required an overnight stay and no patient required a blood transfusion. [source] | ||||||||||