Das et al. release updated information on the HoLEP as proven to be extremely durable and effective for LUTS due to BPH.
Article reference: Das AK, Teplitsky S & Humphreys MR (2019), ‘Holmium laser enucleation of the prostate (HoLEP): a review and update’, The Canadian Journal of Urology, 26 (Aug), pp13-19.
This article highlights HoLEP as an extremely durable and effective treatment for patients suffering with LUTS due to BPH. Comparisons between TURP and HoLEP are discussed throughout from previous literature. Conclusions are drawn that HoLEP is a superior surgical solution than TURP and it could be said that HoLEP is becoming the new gold standard in BPH treatment.
HoLEP is when the “adenoma is enucleated from the surgical capsule and displaced into the bladder before removal with an endoscopic device (transurethral soft-tissue morcellator). The HoLEP technique takes advantage of the distinct anatomical planes to remove the entire prostatic transition zone, thus removing more tissue than TURP and leading to a lower retreatment rate”.
The article goes into detail on the technique of HoLEP that distinguishes it from other BPH treatments. From classical techniques to the newer systems, the procedure in short involves laser fibre “delivered through a laser catheter to help stabilize the laser fibre while at the end of the catheter there is a locking mechanism to keep the laser fibre at a fixed length during the procedure”. The prostatic tissue is then enucleated with precision along the anatomical planes of the prostate. Highlighted is the comparison of techniques between classic three-lobe release and more recent updates of technique and equipment allowing for two lobe enucleation techniques. “Initial reports on these newer techniques suggest a decrease in both enucleation and total operative time, and easier identification of the surgical capsule”.
With improvements in morcellators operative efficiency has enhanced. The difference between the morcellators available are highlighted with the statement made that “most HoLEP surgeons’ prefer the Piranha to the VersaCut due to the improved ergonomic design, efficient tissue removal properties and its safety profile”.
The outcomes and safety profile of HoLEP has a positive analysis with the comparison drawn that “HoLEP is at least equivalent to TURP when comparing long term results, with a lower reoperation rate”. Previous studies are discussed in relation to this and conclude “this procedure has no age limit and is useful for all BPH patients”. Another interesting analysis from this article is patient satisfaction post HoLEP. This is again positive with HoLEP bringing satisfaction post procedure in comparison to other BPH procedures.
Durability is another key factor in determining the success of a procedure and HoLEP proves to be similar to that of TURP. One study found “3 years after their operation, both HoLEP and TURP had similar, stable results which were significantly improved from baseline. The study noted that there was no difference in late complication rates and that reoperation rates were not statistically different”.
Concern patients have regarding their prostate surgery is the impact it may have on their erectile function. A study of 393 patients pre and post operatively showed a small decrease in average IIEF score of 5. Although this is a slight change it is important to highlight to patients retrograde ejaculation post procedure. This is when semen does not emerge through the penis but rather enters the bladder instead. It’s essentially a dry orgasm, where men are still able to climax. A study found that “70.3% of men undergoing HoLEP reported a loss of antegrade ejaculation, while 21% report a reduction in semen quality”.
HoLEP is now recognized as the gold standard for the surgical treatment of BPH and a durable and favorable option for men in comparison to TURP.