In 2013, Holmium Laser Enucleation of the Prostate (HoLEP) May Be the New ‘Gold Standard’

In this review article, we assess why holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostatic hypertrophy (BPH). Meta-analysis comparing HoLEP with both open prostatectomy (OP) and transurethral resection of prostate (TURP) shows TURP to be as effective with less morbidity. More recently, HoLEP has long-term durability data confirming a very low reoperation rate. This article investigates how previous hurdles to the widespread uptake of HoLEP have been overcome. Recent literature shows that the learning curve is actually similar to many other current urological procedures, and that the efficiency of HoLEP is equal to that of other surgical procedures. HoLEP is also beneficial in the growing population of men on anticoagulation who require treatment for BPH. Finally, HoLEP is the only laser treatment for BPH with level 1 evidence and endorsement in both the American Urological Association (AUA) and European Association of Urology (EAU) guidelines.

[1]  A. Westenberg,et al.  Long‐term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years , 2012, BJU international.

[2]  John T. Wei,et al.  Update on AUA guideline on the management of benign prostatic hyperplasia. , 2011, The Journal of urology.

[3]  S. Ahyai,et al.  Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. , 2008, European urology.

[4]  I. Tawil,et al.  Should More Patients Continue Aspirin Therapy Perioperatively?: Clinical Impact of Aspirin Withdrawal Syndrome , 2012, Annals of surgery.

[5]  V. Nargund,et al.  TRANSURETHRAL RESECTION OF THE PROSTATE , 2007, BJU international.

[6]  S. Mittal,et al.  Robot-assisted simple prostatectomy: multi-institutional outcomes for glands larger than 100 grams. , 2012, Journal of endourology.

[7]  A. Tan,et al.  Meta‐analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction , 2007, The British journal of surgery.

[8]  F. Montorsi,et al.  Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. , 2010, European urology.

[9]  Mitsuru Sasako,et al.  Randomised trials in surgery: problems and possible solutions , 2002, BMJ : British Medical Journal.

[10]  D. Cranston,et al.  A double‐blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3‐year follow‐up , 2000, BJU international.

[11]  A. Tubaro,et al.  The Current Role of Open Surgery in BPH , 2006 .

[12]  B-K Choe,et al.  How many cases are necessary to develop competence for laparoscopic radical nephrectomy? , 2009, Journal of endourology.

[13]  M. Elhilali,et al.  Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. , 2006, The Journal of urology.

[14]  C. Bolenz,et al.  Standardized comparison of prostate morcellators using a new ex-vivo model. , 2012, Journal of endourology.

[15]  L. Lerner,et al.  Trends and attitudes in surgical management of benign prostatic hyperplasia. , 2012, The Canadian journal of urology.

[16]  S. Madersbacher,et al.  Transurethral Resection of the Prostate , 2009 .

[17]  P. Gilling,et al.  Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. , 1995, Journal of endourology.

[18]  T. Knoll,et al.  Laser treatment of benign prostatic obstruction: basics and physical differences. , 2012, European urology.

[19]  Mani Menon,et al.  Learning curve using robotic surgery , 2006, Current urology reports.

[20]  CornuJean-Nicolas,et al.  Ex vivo comparison of available morcellation devices during holmium laser enucleation of the prostate through objective parameters. , 2014 .

[21]  S. Madersbacher,et al.  Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. , 2005, European urology.

[22]  J. Lingeman,et al.  Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. , 2013, The Journal of urology.

[23]  Hemendra N Shah,et al.  Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. , 2007, The Journal of urology.

[24]  P. Sweeney,et al.  Impact of pharmacotherapy on the incidence of transurethral prostatectomy for benign prostatic hyperplasia and the implications for surgical training. , 2010, Irish medical journal.

[25]  U. Boylu,et al.  The learning curve of robot-assisted radical prostatectomy. , 2011, Journal of endourology.

[26]  J. Fitzpatrick.  Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia , 2012 .

[27]  J. Lingeman,et al.  Holmium laser enucleation of the prostate: a comparison of efficiency measures at two institutions. , 2005, Journal of endourology.

[28]  Alexander Bachmann,et al.  Critical review of lasers in benign prostatic hyperplasia (BPH) , 2011, BJU international.

[29]  M. Tyson,et al.  Transurethral and Lower Tract Procedures Safety of Holmium Laser Enucleation of the Prostate in Anticoagulated Patients , 2009 .

[30]  A. Scherpbier,et al.  Analysis of pitfalls encountered by residents in transurethral procedures in master-apprentice type of training. , 2010, Journal of endourology.

[31]  A. Westenberg,et al.  A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). , 2003, The Journal of urology.

[32]  F. Chun,et al.  Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster? , 2012, The Journal of urology.

[33]  D. Teber,et al.  Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). , 2007, European urology.