- Email: [email protected]
Holmium laser enucleation of the prostate versus open prostatectomy – single institution experience
5th Meeting of the EAU Section of Uro-Technology (ESUT), 8-10 July 2016, Athens, Greece
O27 Holmium laser enucleation of the prostate versus open prostatectomy – single institution experience Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev M., Enikeev D.V., Khamraev O., Taratkin M.S. I.M. Sechenov First Moscow State Medical University, Dept. of Uronephrology and Reproductive Health, Moscow, Russia INTRODUCTION & OBJECTIVES: Until recently, open prostatectomy (OP) has been considered the technique of choice for the treatment of large-volume prostatic hyperplasia (> 80cm3). Although OP is rather effective, it may lead to an excessive blood loss and a long hospital stay. Nowadays, minimally invasive endosurgical laser techniques gain popularity. One of them, Holmium Laser Enucleation of the Prostate (HoLEP) has already become an integral part of everyday clinical practice. MATERIAL & METHODS: We conduct a retrospective analysis of 397 patients who have been treated and followed up between 2013 and 2015. All patients were divided into two groups: 359 patients in group 1 (prostate volumes > 80cm3) underwent HoLEP; 38 patients in group 2 (prostate volumes > 80cm3) underwent OP. The following variables were compared: length of surgery, extent of blood loss, intraoperative and postoperative complications, objective and subjective voiding parameters, post-voiding residual volume, length of catheterization, and hospital stay. In group 1, the mean age of the patients was 69.1 (58-89) years. The mean prostate volume was 122.4 (80-260) cm3. The mean International Prostate Symptom Score (IPSS) before the surgery was 19.5±4.1, the Quality of Life (QoL) score was 4.1±0.6, the maximal flow rate (Qmax) was 6.0±1.5 ml/s, and the post-voiding residual volume (V res ) was 67.3±33.5 ml. In group 2, the mean age of the patients was 65.2 (61-75) years. The mean prostate volume was 135.4 (100-235) cm3. The mean IPSS before the surgery was 22.1±2.5, the QoL score was 4.0±1.0, the Qmax was 5.0±2.0 ml/s, and the V res was 42.1±35.5 ml. RESULTS: In group 1, the mean length of enucleation was 89.1±29.5 minutes, the mean length of morcellation - 74.0 ± 29.9. The mean resected tissue weight was 97.1 (67-210) g., the catheterization time was 24 hours, and the hospitalization time was 3,1 days. In group 2, the mean length of surgery was 128 (105-180) min. The mean resected tissue weight was 93.2 (70-158) g., the catheterization time was 9.5 (7-12) days, and the hospitalization time was 10.8 (8-15) days (p<0.05). At 6 months postoperatively, the mean IPSS in group 1 was 6.7±1.6, the QoL was 1.9±0.8, the Q max was 21.9±3.3 ml/s, the V res was 16,6±8,5 ml, and the prostate volume was 24.3±7.8 cm3. At 6 months postoperatively, the mean IPSS in group 2 was 5.8±1.8, the QoL was 1.9±1.0, the Q max was 21.2±3.5 ml/s, the V res was 15.0±5.5 ml, and the prostate volume was 26.0±7.1 cm3. In group 1, only 5 patients (1.39%) had postoperative blood loss, none of them required transfusion, whereas in group 2, there were intraoperative blood loss necessitated transfusion in 6 (15.8)% patients (p<0.05). Short-term stress urinary incontinence was observed in 11.2% of patients from group 1 and in 16.5% of patients from group 2 (p>0.05). CONCLUSIONS: OP and HoLEP are effective techniques for the treatment of large-volume prostatic hyperplasia and lower urinary tract symptoms. However, HoLEP has been shown to reduce blood loss and shorten postoperative hospital stay.
European Urology Supplements 15(6), 2016
160
O27 Holmium laser enucleation of the prostate versus open prostatectomy – single institution experience Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev M., Enikeev D.V., Khamraev O., Taratkin M.S. I.M. Sechenov First Moscow State Medical University, Dept. of Uronephrology and Reproductive Health, Moscow, Russia INTRODUCTION & OBJECTIVES: Until recently, open prostatectomy (OP) has been considered the technique of choice for the treatment of large-volume prostatic hyperplasia (> 80cm3). Although OP is rather effective, it may lead to an excessive blood loss and a long hospital stay. Nowadays, minimally invasive endosurgical laser techniques gain popularity. One of them, Holmium Laser Enucleation of the Prostate (HoLEP) has already become an integral part of everyday clinical practice. MATERIAL & METHODS: We conduct a retrospective analysis of 397 patients who have been treated and followed up between 2013 and 2015. All patients were divided into two groups: 359 patients in group 1 (prostate volumes > 80cm3) underwent HoLEP; 38 patients in group 2 (prostate volumes > 80cm3) underwent OP. The following variables were compared: length of surgery, extent of blood loss, intraoperative and postoperative complications, objective and subjective voiding parameters, post-voiding residual volume, length of catheterization, and hospital stay. In group 1, the mean age of the patients was 69.1 (58-89) years. The mean prostate volume was 122.4 (80-260) cm3. The mean International Prostate Symptom Score (IPSS) before the surgery was 19.5±4.1, the Quality of Life (QoL) score was 4.1±0.6, the maximal flow rate (Qmax) was 6.0±1.5 ml/s, and the post-voiding residual volume (V res ) was 67.3±33.5 ml. In group 2, the mean age of the patients was 65.2 (61-75) years. The mean prostate volume was 135.4 (100-235) cm3. The mean IPSS before the surgery was 22.1±2.5, the QoL score was 4.0±1.0, the Qmax was 5.0±2.0 ml/s, and the V res was 42.1±35.5 ml. RESULTS: In group 1, the mean length of enucleation was 89.1±29.5 minutes, the mean length of morcellation - 74.0 ± 29.9. The mean resected tissue weight was 97.1 (67-210) g., the catheterization time was 24 hours, and the hospitalization time was 3,1 days. In group 2, the mean length of surgery was 128 (105-180) min. The mean resected tissue weight was 93.2 (70-158) g., the catheterization time was 9.5 (7-12) days, and the hospitalization time was 10.8 (8-15) days (p<0.05). At 6 months postoperatively, the mean IPSS in group 1 was 6.7±1.6, the QoL was 1.9±0.8, the Q max was 21.9±3.3 ml/s, the V res was 16,6±8,5 ml, and the prostate volume was 24.3±7.8 cm3. At 6 months postoperatively, the mean IPSS in group 2 was 5.8±1.8, the QoL was 1.9±1.0, the Q max was 21.2±3.5 ml/s, the V res was 15.0±5.5 ml, and the prostate volume was 26.0±7.1 cm3. In group 1, only 5 patients (1.39%) had postoperative blood loss, none of them required transfusion, whereas in group 2, there were intraoperative blood loss necessitated transfusion in 6 (15.8)% patients (p<0.05). Short-term stress urinary incontinence was observed in 11.2% of patients from group 1 and in 16.5% of patients from group 2 (p>0.05). CONCLUSIONS: OP and HoLEP are effective techniques for the treatment of large-volume prostatic hyperplasia and lower urinary tract symptoms. However, HoLEP has been shown to reduce blood loss and shorten postoperative hospital stay.
European Urology Supplements 15(6), 2016
160