Presented by: Hen Hendel MD
Rabin Medical Center

Introduction

Laser enucleation of the prostate (HoLEP) is an established endoscopic treatment modality for benign prostatic hyperplasia (BPH), primarily targeting prostates with significant volumes (>80 cc). However, the existing literature on the effectiveness and safety of HoLEP surgery in patients with extremely large prostates (>200 cc) is limited. Therefore, this study aims to evaluate the efficacy and safety of HoLEP surgery in this specific patient population.

Materials

Through a retrospective analysis, we identified a total of 704 patients who underwent HoLEP surgery at our department between 2016 and 2022. The study group comprised patients with prostates exceeding 200 cc, while the control group consisted of patients with prostates sized between 80-199 cc, who underwent surgery in close proximity to the research group.

Results

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We compared 28 patients with prostates larger than 200 cc (average 213.1 cc, range 200-270 cc) to 56 patients with prostates sized between 80-199 cc (average 135.3 cc, range 80-190 cc). Apart from prostate size, there were no significant differences in the characteristics of the groups, except for the presence of a preoperative catheter (53.6% in the study group vs. 41.1% in the control group) and general risk factors.

The duration of the surgery was longer in the study group compared to the control group (median 160 minutes vs. 110 minutes, respectively, p=<.001). However, there were no significant differences in postoperative haemoglobin drop (median 1.15 g/dL per mol 0.75, respectively) or time until catheter removal (96% of the study group and 91% of the control group had catheters removed on the first postoperative day).

All patients in the study group were discharged home without a catheter, in contrast to 92.9% in the control group. Additionally, all patients were successfully weaned from the catheter within 7 days after surgery. Notably, one patient (3.5%) in the study group and three patients (5.3%) in the control group visited the emergency room within 30 days post-surgery.

No significant difference was observed between the study group and the control group in terms of the rate of surgical complications (0% vs. 3.9%, respectively).

Conclusion

This study demonstrates that HoLEP surgery is effective and safe for patients with prostates larger than 200 cc, comparable to HoLEP surgery in smaller prostates, with the exception of a longer surgical duration. These findings support the utilization of HoLEP as a viable treatment option for patients with prostates exceeding 200 cc.

Funding

None

Co-Authors

Yaron Ehrlich, MD
Rabin Medical Center

Abd Elhalim Darawsha, MD
Rabin Medical Center

Gherman Creiderman, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

Michael Frumer, MD
Rabin Medical Center

Tzach Aviv, MD
Rabin Medical Center

Sagi Arieh Shpitzer, MD
Rabin Medical Center

Krenawi Muhammad, MD
Rabin Medical Center

Shayel Bercovich, MD
Rabin Medical Center

Tomer Weizman, MD
Rabin Medical Center

Nadav Dekel Dekel, MD
Rabin Medical Center

Hadar Tamir, MD
Rabin Medical Center

Tomer Hasdai, MD
Rabin Medical Center

Yossi Ventura, MD
Rabin Medical Center

Niv Segal, MD
Rabin Medical Center

Liran Zieber, MD
Rabin Medical Center

Dmitry Enikeev, MD
Medical University of Vienna

David Lifshitz, MD
Rabin Medical Center