J.Stanković, M.Stanković, Lj.Dinić,
Clinical Center Niš, Serbia
Introduction & objectives: Holmium Laser Enucleation of the Prostate (HoLEP) in combination with mechanical morcellation represents new, minimal invasive, surgical procedure in benign hyperplasia of prostate (BPH) treatment. Using this technique, even large prostate can be treated successfully with minimal morbidity. HoLEP technique requires several steps: from acknowledgment of the surgical capsule, enucleation of median and lateral lobes of the prostate and the process of morcellation.
Materials & methods: During one year (October 1st 2011 – September 30th 2012), 50 patients, mean age 69,3 years (58-72) were surgically treated. The mean IPSS value was 24 (Range 16-28). The mean PSA value was 2,32 (0,73-3,60). The prostate volume ranged from 40 to 75 ml, (mean 58,8 ml). Postmictional volume of residual urine ranged from 70 to 180 ml, with a mean value of 163 ml. We used the Laser produced by Lumenis Surgical, VersaPulse with a 550µ fiber, 2,7F. The prostate size should not represent a contraindication. Enucleated lobes were morcellated using a Richard Wolf Morcellator.
Results: Mean enucleation time of the prostate was 68 minutes. Foley catheter removal was after 24 – 48 hours and the mean hospitalization time was 2,5 days. Control examinations were done after 3 and 6 months. Control mean IPSS value was 9,5, Qmax 22ml/sec (11 – 33 ml/sec), PVR with a mean value of 35ml (10-55ml.)
Conclusion: HoLEP is a minimally invasive surgical procedure for BPH treatment that enables the complete removal of the prostate lobes. HoLEP is a procedure with no risk of TUR syndrome, which enables exact hemostasis and short hospital stay. The results are comparable to TURP. Contraindications for HoLEP are: active infection, abnormal homeostasis and unstable cardio-respiratory diseases.