Does prostate morphology affect outcomes after holmium laser enucleation?

To determine whether prostate morphology or technique used has any effect on postoperative outcomes after holmium laser enucleation of the prostate.

A retrospective review of prospectively collected data was completed for all patients undergoing a holmium laser enucleation of the prostate at our institution. Prostate morphology was classified as either "bilobar" or "trilobar" according to the cystoscopic appearance. The baseline characteristics, complications, and postoperative outcomes were collected.

A total of 304 patients with either "bilobar" (n = 142) or "trilobar" (n = 162) prostate morphology were included. The trilobar group was more likely to have longer operative times (112 vs 100 minutes, P = .04), although this difference was not significant on multivariate analysis. The postoperative outcomes were similar between the 2 groups for American Urological Association symptom score, change in American Urological Association symptom score, bother score, maximal flow rate, change in maximal flow rate, postvoid residual urine volume, and complication rate. However, the trilobar group had a significantly greater decrease in their PVR urine volume (296 vs 176 mL, P = .01), a difference that persisted on multivariate analysis. A subset analysis of the trilobar prostates revealed that performing a 2-lobe technique achieved shorter operative and enucleation times, although the difference was not significant.

Those patients with trilobar prostate morphology are more likely to achieve a greater decrease in the PVR urine volume after holmium laser enucleation of the prostate. All other outcomes appeared to be similar between the 2 groups. In addition, a 2-lobe technique can be safely used for trilobar prostates when deemed feasible by the surgeon.