Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results

To determine the feasibility of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation to surgically treat bladder outflow obstruction due to the larger prostate.

The first 14 patients treated with this new combination technique are described. Standard preoperative investigations were performed and all patients were assessed at 1 month postoperatively with an AUA symptom score and peak urinary flow rate (Qmax). Both transurethral (8 patients) and suprapubic (6 patients) morcellation was utilised.

The mean ultrasound volume of the prostate was 98.6 ml (55-200). The mean total operating room time was 98 min (64-190). No patient required blood transfusion but 2 patients required postoperative bladder irrigation. Twelve of the patients were discharged catheter-free the following day. The only significant complication was extraperitoneal extravasation from the suprapubic site in 2 patients. At 1 month the mean Qmax was 25.2 ml/s and the mean AUA score was 7.2.

This combination of techniques offers a minimally morbid method of treating the larger prostate gland.