Presented by: Jonathan Modai MD
UCLA

Introduction

Over the past three decades, Holmium laser enucleation of prostate (HoLEP) has emerged as the gold-standard treatment for benign prostate hypertrophy (BPH), thanks to its ability to achieve profound and durable functional results in a minimally invasive way for prostates of all sizes. Still, widespread adoption has been slow, hindered by a steep learning curve and difficulties in performing the procedure in an efficient way. Understanding factors affecting operative time can allow surgeons to schedule their cases more precisely and may help with resource allocation for challenging cases.

Materials

We performed a prospective observational cohort study of patients undergoing HoLEP by a single surgeon from 2020 to 2022. Demographic, clinical, and radiographic variables were collected for analysis. Univariate and multivariable logistic regression analyses were performed to identify factors affecting surgery time.    

Results

,

A total of 303 patients were included in the analysis. The average age was 70 years (44-86 years), average prostate size was 121cc (20-315cc) and average operative time was 159 minutes (15-414 minutes). Univariate analysis found body mass index, pre-operative catheter dependence, prostate volume, prostate height (anterior-posterior), prostate width (transverse), and prostatic urethral length all affected operative time. Multivariate analysis demonstrated that prostatic urethral length, prostate height, and length-to-width ratio had a clinically significant impact on operative time, with each 1cm increase in prostate height and prostatic urethral length predicting a 38 and 44 min increase in operational time, respectively. Prostates with lower length-to-width ratios were found to be more challenging, requiring 5 minutes more for every 0.1 decrease in this ratio. 

Conclusion

Rather than gland volume, the operative times of our HoLEP procedures were associated with prostatic urethral length, height, and length-to-width ratios. These findings can help surgeons with allocating time and resources properly for cases that may be expected to last longer than others.

Funding

None

Co-Authors

Parth Patel, MD
UCLA

Roi Babaoff, MD
Rabin Medical Center

James Lee,
UCLA

Dong Shin,
UCLA

Kymora Scotland, MD, PHD
UCLA

Matthew Dunn, MD
UCLA