A call for HoLEP: AEEP for mega-prostates (≥ 200 cc)

Area of Science:

• Urology
• Surgical Technology
• Prostate Health

Background:

• Benign prostatic hyperplasia (BPH) is a common condition affecting aging men.
• Holmium laser enucleation of the prostate (HoLEP) is an effective treatment for BPH.
• Evaluating HoLEP outcomes in very large prostates is crucial for surgical planning.

Purpose of the Study:

• To assess the efficiency and efficacy of HoLEP in patients with prostate volumes (PV) ≥200 cc.
• To compare HoLEP outcomes in large prostates (Group 1: PV ≥200 cc) versus smaller prostates (Group 2: PV 80-199 cc).
• To analyze tissue retrieval methods and their impact on HoLEP outcomes in different prostate size groups.

Main Methods:

• Retrospective review of HoLEP cases performed by two surgeons at a tertiary HoLEP center.
• Comparison of 157 patients with PV ≥200 cc to 157 consecutive cases with PV 80-199 cc.
• Analysis of enucleation and morcellation efficiency, tissue retrieval methods, hemoglobin decrease, transfusion rates, and length of stay.

Main Results:

• HoLEP demonstrated greater enucleation efficiency in larger prostates (Group 1) compared to smaller ones (Group 2).
• Cystotomy for tissue retrieval was more frequent in Group 1 (5.7%).
• Group 1 experienced a greater decrease in hemoglobin and a longer length of stay, though functional outcomes (IPSS, Qmax, PVR, catheter-free rates) were similar between groups.

Conclusions:

• HoLEP outcomes are largely independent of prostate volume, even for prostates ≥200 cc.
• Increased length of stay and hemoglobin reduction are observed in patients with larger prostates undergoing HoLEP.
• Alternative tissue retrieval methods like cystotomy may be necessary for very large prostates (≥200 cc).