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Eighteen Years of Holmium Laser Enucleation of the Prostate: A Single Center Experience.

PURPOSE
To report our experience with long-term outcomes of the HoLEP procedure over a period of 18 years.


MATERIALS AND METHODS
A review was performed of a prospectively collected database (March 1998 through June 2016) for patients undergoing HoLEP for symptomatic BPH performed or supervised by a single expert surgeon. Demographic and perioperative data were collected including the International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), and Prostate Specific Antigen (PSA). In addition, perioperative and late adverse events were also assessed.


RESULTS
After a median follow-up of 9.1 years, 1476 patients were included with a mean age of 70.7 years. The mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. IPSS (15.9± 6.5 vs. 6.8± 5.6, p<0.001) and QoL (3.1± 1.4 vs. 1.5± 1.4, p<0.001) scores were both significantly improved after HoLEP, when compared to pre-operative values. Likewise, Qmax and PVR were significantly improved (7.2±4.0 vs. 17.7±10.4 mL/Sec, p<0.001); (204± 258 vs. 43± 73 Ml, p<0.001) for 132 patients who could be followed over 10 years. Perioperatve blood transfusion was required in 0.8% of patients. PSA values were significantly reduced by 66.7% at the most recent follow-up (p<0.001). Post-operative complications included urethral stricture and bladder neck contracure in 21 (1.4%) and 30 (2.1%) patients, respectively. Redo HoLEP was required in 21 patients (1.4%).


CONCLUSIONS
Holmium laser enucleation of the prostate is a safe, effective and durable procedure for treatment of benign prostatic hyperplasia over long-term follow-up.