What is the effectiveness of Holmium Laser Enucleation of the Prostate (HoLEP) for treating Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Holmium Laser Enucleation of the Prostate (HoLEP) is a highly effective treatment for Benign Prostatic Hyperplasia (BPH), offering excellent long-term outcomes with fewer complications than traditional surgical approaches. The procedure involves using a high-powered holmium laser to precisely remove enlarged prostate tissue that obstructs urine flow, followed by morcellation to extract the tissue. According to the 2023 European Association of Urology guidelines 1, HoLEP demonstrates similar mid- to long-term efficacy to other surgical options, such as bipolar transurethral enucleation of the prostate (B-TUEP) and open prostatectomy (OP), for larger prostates (>80 ml).

Key Benefits of HoLEP

• Significant improvement in urinary flow rates, with average increases of 15-20 ml/second
• Reduction in post-void residual urine volumes by 80-90%
• Low retreatment rate of approximately 1-2% at 5 years, compared to 5-10% for TURP (transurethral resection of the prostate) 1
• Shorter catheterization and hospitalization times, reduced blood loss, and fewer blood transfusions compared to other surgical options 1

Patient Selection and Considerations

The choice of treatment depends on the patient's evaluation, ability of the treatment to change the Male LUTS, and prostate volume 1. HoLEP is particularly advantageous for larger prostates (>80-100g) where other surgical options may be less suitable. The 2023 European Association of Urology guidelines recommend HoLEP as a suitable option for the treatment of LUTS/BPH, depending on the surgeon's expertise 1.

Potential Side Effects and Complications

Potential side effects of HoLEP include temporary urinary urgency (30-40% of patients), retrograde ejaculation (70-80%), and a small risk of urinary incontinence (1-2%) that usually resolves within 3-6 months 1. However, the overall complication rate is low, and HoLEP is considered a safe and effective treatment option for BPH.

From the Research

Effectiveness of HoLEP for Treating BPH

The effectiveness of Holmium Laser Enucleation of the Prostate (HoLEP) for treating Benign Prostatic Hyperplasia (BPH) has been extensively studied. Key findings include:

• HoLEP has become a size-independent gold standard for surgical management of BPH, as indicated by the American Urological Association (AUA) guidelines 2, 3.
• The procedure has been shown to be safe and effective, with durable long-term outcomes, extending beyond 10 years 2.
• HoLEP has been demonstrated to significantly improve voiding symptoms and urodynamic parameters, with improvements in peak urinary flow rate, post-void residual urine, International Prostate Symptom Score, and quality-of-life index 4, 5.

Comparison with Other Treatments

Studies have compared HoLEP to other treatments, including Transurethral Resection of the Prostate (TURP). Key findings include:

• HoLEP has been shown to have a more favorable side effect profile compared to TURP, with reduced hospital stay, complications, and cost 3.
• HoLEP is the only procedure that is AUA guideline-endorsed for all prostate sizes for the surgical treatment of BPH 3.

Safety and Complications

The safety and complications of HoLEP have been evaluated in several studies. Key findings include:

• Intraoperative complications, such as severe hemorrhage, bladder wall injury, and ureteral orifice injury, have been reported, but are relatively rare 6.
• Postoperative complications, such as fever, bladder tamponade, and acute urinary retention, have also been reported, but are generally mild and self-limiting 6.
• Long-term postoperative complications, such as urinary incontinence and urethral strictures, have been reported, but are relatively rare 6.

Efficacy in Different Patient Populations

The efficacy of HoLEP in different patient populations has been evaluated. Key findings include:

• HoLEP has been shown to be equally effective in managing BPH patients with either voiding or storage lower urinary tract symptoms (LUTS) 5.
• The procedure has been demonstrated to be safe and effective in patients with high-risk profiles, such as those with large prostate sizes or previous prostate reducing procedures 3.