Best Practices & Benign Disease
Introduction & Objective : Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for patients with benign prostatic hyperplasia (BPH). Inability to finish the procedure is a possible complication of the procedure that can lead to the need for a second HoLEP procedure or even conversion to suprapubic prostatectomy. The purpose of this study was to investigate the incidence and reasons as to why certain patients undergoing HoLEP procedures could not be successfully completed.
Methods : A retrospective review, from an IRB approved database, of 515 patients that underwent a HoLEP by a single-surgeon at our institution between January 2012 and December 2017 was performed. Patients who were unable to complete the procedure were retrospectively identified and analyzed via chart review. Univariate analysis was performed for demographics and baseline characteristics.
A total of 7 (1.4%) patients undergoing HoLEP who could not be completed were identified. All patients required either a 2nd HoLEP procedure (3/7) or conversion to suprapubic prostatectomy (4/7). Patient 1 had a bladder that would not expand and morcellation was not possible. The patient subsequently underwent a second HoLEP operation one week later to undergo morcellation of tissue. Patient 2 underwent cystoscopy at the start of HoLEP procedure and was found to have a bloody prostate. The procedure was stopped and converted to open suprapubic prostatectomy. A total of 300 grams of prostatic tissue was removed. In patient’s 3, 4, and 5, the cystoscope was unable to reach the end of the bladder, so the operation was stopped and subsequently converted to suprapubic prostatectomy. Lastly, in patient 6 and 7, enucleation was completed, but the patients afterwards became edematous due to fluid overload secondary to absorption. A second HoLEP procedure was required for morcellation of tissue. Details of all 7 patients are listed below in Table 1. Mean prostatic gland volume on TRUS was 93.6 ± 56.6 grams for all patients. The average age and body mass index was 70.5 ± 8.5 years and 30 ± 11.9, respectively.
Conclusions : HoLEP is a safe and effective treatment for patients suffering from lower urinary tract symptoms. Inability to complete initial operation leading to necessity for a second HoLEP operation or conversion to open procedure is a rare but possible complication. Management and counseling should be directed towards providing patients with information in regards to this possibility.