[Our experience of holmium laser enucleation of the prostate]

Surgical treatment of benign prostatic hyperplasia (BPH) is influenced by a rapidly growing number of technologies.

To determine the surgical potential of holmium laser enucleation of the prostate (HoLEP) and the rate of postoperative complications during the learning curve.

A total of 98 patients undergoing HoLEP in the surgical department of the Clinical Hospital "Mother & Child" during the period from January 2018 to May 2020 were included in the study. HoLEP was performed by a single surgeon with previous experience in transurethral procedures. The criteria for inclusion in the study group were as follows: moderate-to-severe lower urinary tract symptoms, prostate volume > 40 cm3, maximum flow <15 ml/sec, the volume of residual urine > 50 ml. The exclusion criteria were the following: inflammatory process in the lower urinary tract, genitourinary malignancy, previous urinary tract interventions. The evaluated criteria included age, prostate size, International Prostate Symptoms Score (IPSS and QoL), bladder diary, PSA, uroflowmetry, total operative time, length of catheterization, complications according to the Clavien-Dindo Classification, and length of stay.

During pathologic study, two cases of incidental prostate cancer (2.1%) were detected. The relationships between the prostate size and operative time (p<0.05), operative time and length of stay (p<0.05) were found. The total rate of complications was 16.3%. There were no complications more or equal IIIb according to the Clavien-Dindo Classification. The most dangerous complications were injuries of the bladder wall and ureteral orifice (31.25% and 18.75% among all complications, respectively).

It should be considered that a large "middle lobe" is associated with a high risk of injury of the ureteral orifices. In our series, there were 5 cases of bladder tamponade, while bladder injuries during the morcellation developed in the first 10 patients.

HoLEP is a reasonable alternative to TURP for surgical treatment of BPH and is considered a safe procedure for patients taking anticoagulant and antiplatelet drugs. Past experience of TURP allows to learn the technique faster and to reduce the number of complications.