[Quality of life and outcome after holmium laser enucleation of the prostate (HoLEP)]

Comparison of Perioperative Outcomes of Holmium Laser Enucleation of the Prostate for Standard (≤149 ml) Versus Very Large (≥150 ml) Prostate Glands: Retrospective Analysis of a Propensity Score Matched Cohort of 326 Patients

Background and objective

Our objective was to evaluate whether a very large prostate volume significantly affects the incidence of perioperative complications and compromises outcomes among patients undergoing holmium laser enucleation of the prostate (HoLEP).

Methods

We retrospectively analyzed data for 1815 adult patients who underwent HoLEP at Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, between January 2019 and May 2024. Patients were divided into two groups according to their prostate volume: ≤149 ml (group A) and ≥150 ml (group B). Propensity score matching on age, body mass index, American Society of Anesthesiologists physical status, and the presence of an indwelling catheter was used to balance baseline differences. A Mann-Whitney U test was used for comparison of continuous variables between the groups, and a χ2 test for comparison of categorical variables, with p < 0.05 considered statistically significant. Postoperative complications were assessed according to the Clavien-Dindo classification.

Key findings and limitations

After propensity score matching, 163 matched cases per group were analyzed. Group B had significantly longer median total operative time (76 vs 47 min; p < 0.001), enucleation time (42 vs 26 min; p < 0.001), coagulation time (11 vs 6 min; p < 0.001), and morcellation time (15 vs 7 min; p < 0.001). Clavien-Dindo grade ≥IIIb complications (8.7% vs 1.2%; p = 0.02) and blood transfusion (2.5% vs 0%; p = 0.045) were significantly more frequent in group B. Catheterization time (1.9 vs 2.0 d; p = 0.01) and the proportion of patients with postoperative residual urine volume ≤50 ml (85.2% vs 80.2%; p = 0.18) were comparable between the groups. Limitations include the retrospective and single-center study design.

Conclusions and clinical implications

Prostate volume ≥150 ml is associated with a longer operative time, a higher rate of major complications, and a more frequent need for blood transfusion. Therefore, HoLEP for prostate glands ≥150 ml should be performed in experienced high-volume centers.

Patient summary

We compared outcomes of laser surgery for enlarged prostate glands of different sizes. We found that while the surgery is generally effective for very large prostates, it takes longer and has a higher risk of complications in comparison to more typical prostate sizes. However, this procedure is still the best treatment available for prostate enlargement and should be carried out in high-volume hospitals specializing in this treatment.

The Clinical Symptoms and Psychological Status of Biofeedback Electrical Stimulation Combined with Pelvic Floor Muscle Training during the Treatment of Mild Stress Urinary Incontinence after Holmium Laser Enucleation of the Prostate

INTRODUCTION

To study the clinical symptoms and psychological status of biofeedback electrical stimulation combined with pelvic floor muscle training during the treatment of mild stress urinary incontinence (SUI) after holmium laser enucleation of the prostate (HoLEP).

METHODS

Group A was treated by biofeedback and electrical stimulation; Group B was treated by pelvic floor muscle training; and Group C was treated by biofeedback and electrical stimulation combined with pelvic floor muscle training. Patients in the 3 groups had follow-up evaluations every 8, 16, and 24 weeks. Clinical symptoms of urinary incontinence were assessed using the 24-h urinary pad test, the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF); and psychological status was evaluated using the modified Hospital Anxiety Depression Scale (HADS).

RESULTS

The results of ICIQ-UI-SF showed that there were differences within and between the three groups at 8 weeks, 16 weeks, and 24 weeks (p < 0.05). The results of the 24-h pad tests were similar (p < 0.05), except for no difference between group B and group C at 8 weeks (p > 0.05). In the study with the score of HADS >35, the differences among the three groups were statistically significant (p < 0.05). There was no significant difference among the three groups at 0 and 8 weeks (p > 0.05). There were differences in the results between group C and the other two groups at 16 and 24 weeks of treatment (p < 0.05). For patients with HADS <35 at week 0, the results were basically the same except for the difference between groups at week 8. HADS of all patients were no statistical difference (p > 0.05).

CONCLUSIONS

Biofeedback electrical stimulation combined with pelvic floor muscle training is an efficient nonsurgical combination therapy for the symptoms of SUI after HoLEP for benign prostatic hyperplasia. In addition, the recovery of the patient's psychological state does not coincide with the recovery of urinary incontinence; therefore, we propose that patients still need additional psychological treatment after SUI disappears.

Patient reported outcome and quality of life measured by a simple questionnaire in patients with symptomatic benign prostate hyperplasia treated by holmium laser enucleation of the prostate (HoLEP)

Introduction

Holmium Laser Enucleation of the Prostate (HoLEP) is established as an effective transurethral treatment option for LUTS due to BPH with improved postoperative outcome. The aim of this study was to evaluate the medium-term results by patient reported outcome measurement and to detect potential risk factors for postoperative complications or impaired outcome.

Methods

We performed a retrospective single-center cohort study including all patients undergoing HoLEP in the study center between April 2019 and December 2021. Therefore, perioperative parameters and postoperative outcome was documented and all patients were asked for their outcome (PROM), complications, IPSS, QoL and changes in sexual and continence function by a questionnaire at a single time point.

Results

In the study period, a total of 541 patients with a mean age of 72.5 ± 8.4 years were treated by HoLEP in the study center. 71.7% of the questionnaires were returned after a mean observation period of 14.9 ± 6.3 month. 91% of the patients reported to the single-timepoint questionnaire reporting a good satisfaction with the procedure and a low postoperative complication rate. The international prostate symptom score could be reduced significantly to 6.2 ± 5.7 (preoperative 19.0 ± 7.2; p < 0.001). Patients with an ASA score ≥ 3, prostate volume > 80 ml, medication with platelet inhibitors or DOAK or preoperative need of an indwelling catheter didn't show an increased complication rate.

Conclusion

The overall satisfaction with the procedure and its results are high. We could not identify any independent risk factors for postoperative complications after HoLEP. The used questionnaire is a simple tool for postoperative patient reported outcome measurement with a good correlation to clinical parameters.