Holmium laser enucleation of the prostate combined with mechanical morcellation: Two years of experience with 196 patients

Background and Purpose: For 2 years, we followed a cohort of consecutive men who underwent holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation to relieve bladder outlet obstruction with the goal of determining the safety, efficacy, and durability of this procedure. Patients and Methods: From January 2000 to June 2001, 196 men with symptomatic bladder outlet obstruction were treated with HoLEP at our institution. A pulsed high-power 80 W holmium laser was used, with the enucleated tissue being removed with a transurethral mechanical morcellator. All patients underwent volume evaluation, peak urinary flow rate estimation (Q(max)), postvoiding residual urine volume measurement, International Prostate Symptom Score determination, and a single-question quality of life (QoL) score. Immediate and long-term complications were assessed. Results: The total operative time averaged 83.2 +/- 42.5 minutes, and the average resected weight was 36 +/- 26 g. The morcellation efficiency was 2.8 +/- 1.0 g/min. The mean catheter time was 19 +/- 13 hours, and the hospital stay averaged 1.5 +/- 1.0 days. The mean hemoglobin value and serum sodium concentration did not change, and no patient needed a blood transfusion or experienced hyponatremia. With a mean follow-up of 12.6 +/- 4.9 months (range 6-24 months), significant improvement has been seen in all voiding measures, with a 148% increase in Qmax and a 60% improvement in the symptom score at 1 year postoperatively. Overall, 89% of the patients noticed an improvement in QoL. The complications have been irritative urinary symptoms in 23%, bladder mucosal injury in 6.6%, and transient stress incontinence in 7.1%. Eight patients (4.0%) have required reoperation. Conclusion: The HoLEP procedure is an efficacious surgical intervention for symptomatic bladder outlet obstruction with minimal associated morbidity. Wider application and technical refinement will allow the surgeon to reduce the operative time and to render mechanical morcellation safer.