Three-Year Outcome following Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation in 330 Consecutive Patients

Objectives: A prospective study to assess safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Methods: Between January 2000 and July 2003, 330 consecutive patients underwent HoLEP at our institution. All patients were pre-operatively assessed with transrectal ultrasound gland volume evaluation, maximum urinary flow rate (Q_max), international prostate symptoms score (IPSS), and the single-question quality of life (QoL). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 1-, 3-, 6-, 12-, 18-, 24-, and 36-mo follow-up with the same examinations. Results: Patients' mean age was 66 ± 8.1 yr; prostate volume was 62 ± 34 cc. Enucleation time was 45.4 ± 22.9 min and morcellation time 17.3 ± 14 min, whilst resected weight was 40 ± 27.5 g. Catheter time was 23 ± 14.7 h and hospital stay was 48 ± 26 h. Mean serum hemoglobin and sodium did not drop significantly from baseline after the procedure (p = 013). A significant improvement occurred in Q_max (25.1 ± 10.7 ml/s), IPSS (0.7 ± 1.3), and QoL (0.2 ± 0.5) at the 3-yr follow-up compared with baseline (p <0.05). Twenty-eight percent of patients complained of irritative urinary symptoms, typically self-limiting after 3 mo; transient stress incontinence was reported in 7.3% of patients. Nine patients (2.7%) had persistent BOO, requiring reoperation. Conclusions: HoLEP represents an effective and safe surgical intervention. The relief from BOO also proved to be durable after 3-yr follow-up. The present report adds to the evidence that HoLEP could be the standard "size-independent" surgical treatment for symptomatic BPE-related BOO.