Presented by: Francisco Javier Sánchez Gutierréz MD
Hospital Regional de León ISSSTE

Introduction

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 60 years of age, reaching an incidence close to 80% in those over 70 years of age. Historically, the surgical treatment of BPH was transurethral resection of the prostate (TURP), currently scientific evidence has positioned holmium laser enucleation of the prostate (HOLEP) as the treatment of choice for BPH. The HOLEP in Latin America continues to grow in popularity and application; implying a great challenge its implementation in the public health system, development of surgical technique, and training of health personnel. Objectives: Analyze the technical-surgical advances, time surgery, blood loss and complications since the implementation of the HOLEP as a treatment standard for patients with BHP in a reference center of the public health system in Mexico.

 

Materials

We conducted a retrospective study in patients who underwent HOLEP over a period of 8 years, using multivariable and medical records analysis.

Results

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Information was collected from 253 HOLEP in patients with LUTS, performed between August 28, 2016, to May 29, 2023. The surgical technique in bloc with early release of the sphincter was the most performed with a total of 174 surgeries; the "bilobar" technique in 71 cases; than the "trilobar" technique in 8 cases. Intraoperative bleeding was analyzed, finding an average bleeding of 387ml in 2016, compared to a reported bleeding of 141ml in 2023. The hospital stays in 2016 was 1.42 days on average; compared to 0.35 days in 2023. The amount of tissue obtained through HOLEP in 2016 averaged 35.3 grams, compared to 63.4 grams in 2023; while the surgical time went from 151 minutes to 124 minutes respectively. 22 complications were reported (13 urethral strictures, 5 bladder neck contractures, 1 hypovolemic shock, 1 ureteral injury, and hospital readmission due to postoperative bleeding secondary to HOLEP, representing 8.6% of adverse events.

Conclusion

HOLEP is the new gold standard for BHP treatment, the acquisition of surgical skill leads to a decrease in postoperative bleeding, hospital stay, being a procedure that can be performed safely on an outpatient basis without increasing the incidence of complications.

Funding

None

Lead Authors

Cristian Ivan Pelayo Avendaño, MD
Hospital Regional de Alta Especialidad ISSSTE Morelia

José Ernesto Aguayo Becerra, MD
Hospital Regional de León ISSSTE

Ramses Arturo Rosas Calaña, MD
Hospital Regional de León ISSSTE

Isaac Daniel Arreola Jiménez, MD
Hospital Regional de León ISSSTE

Ricardo Agustin Leal Marroquin, MD
Hospital Regional de León ISSSTE