Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia

Objectives. To report our experience with holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of symptomatic benign prostatic hyperplasia (BPH). Methods. From January 2000 to May 2001, 155 consecutive patients with BPH underwent HoLEP combined with mechanical morcellation and were followed up for at least 6 months. A pulsed high-powered 80-W holmium-neodymium:yttrium-aluminum-garnet laser was used (power setting 2.0 J/pulse, 35 pulses/s, and 70 W). The enucleated tissue was removed by a transurethral mechanical morcellator. Results. The preoperative mean prostate volume was 53 ± 39 cm³; 38.7% of patients had an estimated gland volume greater than 50 cm³; 30.8% had BPH complicated by urinary retention, bladder calculi, bladder diverticula, or urethral stricture. The total mean operative time was 87 ± 44 minutes, the resected weight was 37 ± 26 g, and the morcellation efficiency was 1.9 ± 1.6 g/min. The catheter time was 18 ± 13.5 hours and the hospital stay 1.5 ± 1.0 days. No patient needed a blood transfusion or experienced hyponatremia. The patients were followed up for a mean of 13 ± 5 months (range 6 to 24). The International Prostate Symptom Score, quality-of-life score, and peak urinary flow rate had improved significantly 1 month after HoLEP and continued to improve in the next few months, regardless of whether the gland volume was more or less than 50 cm³. Conclusions. HoLEP combined with mechanical morcellation is an efficient surgical intervention for BPH, regardless of gland size.