The new gold standard for surgical management of BPH: an institutional experience with 1000 HoLEPs

Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent, endoscopic management option for benign prostatic hyperplasia (BPH). HoLEP offers a distinct advantage for patients who are at high-risk for bleeding whilst preserving prostatic tissue for pathology analysis, unlike photoselective vaporization. Further, HoLEP avoids the need for cystotomy, unlike simple open and robotic prostatectomy, by using intravesical morcellation. We report our experience with the first 1000 HoLEP procedures at our institution.

We performed a retrospective review of all HoLEP procedures performed at our institution from 2013-2021 to capture patient demographics, procedure details, and outcomes. Unpaired two sample t-tests were used to compare outcomes, p < 0.05 considered statistically significant.

The average patient age and BMI were 71.1 y (±8.1 y) and 27.9 kg/m² (±4.9 kg/m²), respectively. 69.4% of patients were on an alpha blocker and 33.3% of patients were on a 5-alpha reductase inhibitor preoperatively. 11.2% of cases were redo outlet procedures including after prior Urolift®. Average prostate volume was 108.0 mL (±66.5 mL) and average enucleation time was 119.7 min (±56 min). On average, 65 g (±53.2 g) prostate tissue was resected. Pre-operative and post-operative flow, post-void residual (PVR), AUA symptom score (AUA-SS), and quality of life (QoL) score showed notable improvement. Complication rates remained low, with the most common including blood transfusion (2.8%), urethral stricture (1.9%), and persistent stress urinary incontinence (1.3%).

HoLEP is emerging as the new surgical gold standard for BPH. A steep learning curve remains for urologists. Nonetheless, this procedure holds great promise in improving patient experiences with BPH.