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Updated: Mar 15, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Does Cystolitholapaxy at the Time of Holmium Laser Enucleation of the Prostate Affect Outcomes?
Teerayut Tangpaitoon1, Tracy Marien1, Mustafa Kadihasanoglu1
1Vanderbilt University Medical Center, Nashville, TN.
Insights
Holmium laser enucleation of the prostate (HoLEP) with concurrent holmium laser cystolitholapaxy (HLC) is effective for treating benign prostatic hyperplasia and bladder stones. While early urinary incontinence is common, it typically resolves within 3-6 months.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Laser Technology
Background:
- Benign prostatic hyperplasia (BPH) and bladder stones often coexist, requiring simultaneous treatment.
- Holmium laser enucleation of the prostate (HoLEP) is a standard BPH treatment.
- Holmium laser cystolitholapaxy (HLC) addresses bladder stones.
Purpose of the Study:
- To compare the outcomes of HoLEP with and without concurrent HLC.
- To evaluate the safety and efficacy of combined HoLEP and HLC procedures.
- To assess the impact of concurrent HLC on HoLEP outcomes.
Main Methods:
- Retrospective review of a prospectively maintained database.
- Comparison of 279 patients undergoing HoLEP (Group 1) versus 41 patients undergoing HoLEP with concurrent HLC (Group 2).
- Analysis of patient characteristics, operative times, and postoperative outcomes.
Main Results:
- Concurrent HLC (Group 2) resulted in longer operative times (172 vs. 146 minutes) and a higher rate of early urinary incontinence (26.8% vs. 12.5%).
- Postvoid residual volumes were slightly higher at 6 weeks in Group 2, but this was not clinically significant.
- Blood loss, urinary symptom scores, flow rates, and overall complication rates were similar between groups.
Conclusions:
- Concurrent HoLEP and HLC is a viable treatment option for patients with BPH and bladder stones.
- Patients should be counseled regarding the high rate of temporary early urinary incontinence.
- Complete resolution of urinary incontinence is expected within 3-6 months post-surgery.
Objective:
To compare the outcomes of men undergoing holmium laser enucleation of the prostate (HoLEP) with and without concurrent holmium laser cystolitholapaxy (HLC).
Patients And Methods:
A retrospective review of a prospectively maintained database was performed on patients who underwent HoLEP: Group 1 (N = 279) and HoLEP with concurrent HLC: Group 2 (N = 41) between June 2008 and July 2015. Patient characteristics and outcomes were compared.
Results:
The average bladder stone burden was 3.6 cm. Preoperative characteristics were similar. Not surprisingly, group 2 had longer operative times (172 minutes vs 146 minutes, P = .01) (Table 1) whereas postvoid residual was slightly higher than in group 1 at 6-week follow-up (30 mL vs 52 mL, P = .04). This difference was not clinically significant. Group 2 had a higher rate of early urinary incontinence (UI) (26.8% versus 12.5%, P = .03) (Table 3); however, only 2 patients in the entire cohort experienced long-term UI. Otherwise, outcomes including blood loss, urinary symptom scores, flow rates, and complication rates were similar between the 2 groups.
Conclusion:
This is the largest series of HoLEP with concurrent HLC studied. Patients undergoing concurrent HoLEP and HLC can be counseled that although there is nearly a 30% rate of UI immediately following surgery, they can likely expect complete resolution by 3-6 months. Holmium laser treatment should be considered in all patients with benign prostatic hyperplasia with bladder outlet obstruction and bladder stones, as this multimodality tool treats both pathologies, and results in excellent outcomes.
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