Day-case holmium laser enucleation and mechanical morcellation of the prostate

Background. Holmium laser enucleation of the prostate (HoLEP) is increasingly being used as an alternative to transurethral resection of the prostate (TURP) and transurethral electrovaporisation of the prostate (TVP), the "gold standard" procedures for treating symptomatic benign prostatic hyperplasia. Mechanical tissue morcellation was introduced in 1998, and its efficiency could be improved. We investigated the efficiency and complication rate of a morcellator in a day-case setting. Methods. From 2004 to 2008, 137 men were treated with an 80W holmium:YAG laser and subsequent tissue morcellation. Results. The average patient age was 68.0 +/- 7.1 (51-86) years. Morcellation time was 8.6 +/- 6.8 (1-35) min. The weight of the resected tissue was 36.6 +/- 30.0 (2-175) g. The total time for the procedure was 69.6 +/- 28.7 (29-150) min, and the efficiency of morcellation was 5.0 +/- 2.6 (0.2-11.5) g/min. The complication rate due to morcellation was 4.3%. Conclusion. HoLEP with mechanical morcellation is safe even in a day-case setting. The total procedure time approximates that for TURP, so a longer theatre time loses significance as an argument against the method. Complications are rare and not severe. Further technical improvement is desirable.