Introduction & Objective :
Endoscopic enucleation of the prostate is currently the first treatment option in patients with BPH over 80 cc. However, enucleation in cases of giant-sized glands (>200cc) is believed to potentially be a more complicated and time-consuming procedure.
Methods : Our retrospective study included 13 patients aged 67.2 (54-89) years with infravesical obstruction (IPSS>20, Qmax<10) due to BPH, who underwent HoLEP. Patients with urethral strictures, bladder stones, acute inflammation of the genitourinary tract or a history of prior prostate surgery were excluded. For enucleation, we used VersaPulse (Lumenis, Israel) with a 550 µm laser fiber. Tissue removal from the bladder was performed with the help of a Piranha morcellator (Richard Wolf, Germany). Preoperatively and six months after surgery we evaluated IPSS, QoL, Qmax and post-void residual volume. All statistical analyses were performed using SPSS Statistics 22.0 (SPSS Inc., Chicago, IL, USA). A p-value of 0.05 was chosen as a threshold for statistical significance.
Mean BPH volume was 217.1 cc (200-250 cc). Mean surgery time was 148.1±19.3 and a mean mass of removed tissue was 171.2 g. Catheterization time was 32.4 hours and hospital stay was 3.4 (3-4) days. After removal of urethral catheter, 2 (15.4%) patients had de novo stress urinary incontinence, urgency was observed in 1 patient (7.7%). At 6 months, there were no patients with stress urinary incontinence. There were one case of clot retention and one case of urinary infection. Six months after surgery, we observed a statistically significant improvement in IPSS, QoL, Qmax and post-void residual volume in all the patients (p
Endoscopic enucleation is a safe treatment option for BPH over 200 cc with reliable functional outcomes up to 2 years after surgery. Rate of postoperative complications after HoLEP of giant BPH did not exceed that of HoLEP for 80-200cc glands. Endoscopic enucleation requires short hospital stay and catheterization duration and allows for fast return to normal life.
Dmitry Enikeev– Deputy Director for Science, Institute for Urology and Reproductive health, Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Mark Taratkin– Researcher, Institute for Urology, Sechenov University, Moscow, Moskva, Russia
Deputy Director for Science
Institute for Urology and Reproductive health, Sechenov University
Moscow, Moskva, Russia
Experienced in TURP (>300 surgeries).
Experienced in upper urinary tract endosurgery (PCNL >200, RIRS >200).
2008-Present: Multiple upper and lower urinary tract surgeries;
2011-Present: HoLEP (400 surgeries);
2011-Present: En-bloc enucleation of bladder tumor (50 surgeries);
2016-Present: ThuLEP (>400 surgeries);
2016-Present: Thulium en-bloc enucleation of bladder tumor (>80 surgeries);
2016-Present: Brachytherapy (>40 surgeries); prostate cryoablation (70 surgeries), renal cancer cryoablation (30 surgeries);
Apr 2017-Present: Irreversible electroporation (10 surgeries);
Apr 2017-Present: MR-fusion prostate biopsy (80 procedures).
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia