Presented by: Vladislav Petov MD
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

Introduction

Current EAU and AUA guidelines suggest endoscopic enucleation of the prostate (EEP) for all the patients with BPH regardless of the prostate volume.  However, in patients with enormous prostates (≥ 200 cc) EEP is associated with prolonged surgery duration and sometimes looks like herding cats for unexperienced surgeon. Some surgeons prefer simple prostatectomy in such cases. The aim of our study is to evaluate efficacy and safety of EEP in patients with BPH ≥ 200 cc and to make a conclusion on its reasonability in such difficult setting.

Materials

A retrospective single-center study was conducted in the Institute for Urology and Reproductive health of Sechenov University between 2020-2023 years. Inclusion criteria were as follows: preoperative prostatic volume ≥ 200 cc; the management of BPH was performed using Holmium laser enucleation of the prostate (HoLEP) or Thulium fiber laser enucleation of the prostate (ThuFLEP). Exclusion criteria: previous surgical interventions for BPH, no postsurgical follow-up data.

Results

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A total of 53 participants were enrolled in the study: 28 of them underwent HoLEP and 25 – ThuFLEP. The baseline stats were as follows: mean age - 68.4±6.9 years, median prostatic volume – 210 (200;236) cc, mean PSA – 6.4±3.7 ng/ml, mean Qmax – 8.3±1.8 ml/sec, median PVR – 60 (50;72.5) ml, median IPSS – 23 (22;24), median QoL 4 (3;5). Median operation duration was 81 (59;126) min, median enucleation weight – 97 (68;169) g, catheterization time – 1 (1;2) days, hospital stay 3 (3;4) days. Transient stress urinary incontinence was observed in 4 patients; injury of the bladder wall  – in 1 patient; injury of the ureteral orifice – in 1 patient (Clavien-Dindo I); clot retention– in 4 patients (Clavien-Dindo II); acute urinary retention – in 1 patient; clot retention with surgical revision – in 2 patients; delayed morcellation  – in 1 patient (Clavien-Dindo III); death due to thromboembolia of the pulmonary artery (Clavien V) – in 1 patient with the prostatic volume 310 cc. At 3-months follow-up all functional parameters significantly improved: prostatic volume reduced to 20 (15;30) ml; PSA – 1.1±0.2 ng/ml; Qmax – 21.8±2.7 ml/sec; PVR – 10 (0;20) ml; IPSS – 4 (3;7); QoL 2 (1;2), p<0.01. Among late complications there were stress urinary incontinence in 1 patient and bladder neck sclerosis in 1 patient.

Conclusion

The results of our study affirm that EEP is a size independent BPH management procedure and it should be considered as a viable optional for surgical treatment in patients with prostates ≥ 200 cc too.

Funding

None

Lead Authors

Alexander Androsov, MD
Institute for Clinical medicine, Sechenov University

Co-Authors

Andrey Morozov, MD, PhD
Institute for Urology and Reproductive Health, Sechenov University

Dmitry Enikeev, MD, PhD
Department of Urology, Medical University of Vienna