Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 6/2012

01-12-2012 | Benign Prostatic Hyperplasia (K McVary, Section Editor)

In 2013, Holmium Laser Enucleation of the Prostate (HoLEP) May Be the New ‘Gold Standard’

Authors: Simon van Rij, Peter J. Gilling

Published in: Current Urology Reports | Issue 6/2012

Login to get access

Abstract

In this review article, we assess why holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostatic hypertrophy (BPH). Meta-analysis comparing HoLEP with both open prostatectomy (OP) and transurethral resection of prostate (TURP) shows TURP to be as effective with less morbidity. More recently, HoLEP has long-term durability data confirming a very low reoperation rate. This article investigates how previous hurdles to the widespread uptake of HoLEP have been overcome. Recent literature shows that the learning curve is actually similar to many other current urological procedures, and that the efficiency of HoLEP is equal to that of other surgical procedures. HoLEP is also beneficial in the growing population of men on anticoagulation who require treatment for BPH. Finally, HoLEP is the only laser treatment for BPH with level 1 evidence and endorsement in both the American Urological Association (AUA) and European Association of Urology (EAU) guidelines.
Literature
1.
Keoghane SR, Lawrence KC, Gray AM, et al. A double-blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3-year follow-up. BJU Int. 2000;85:74–8.PubMedCrossRef
2.
McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.PubMedCrossRef
3.
• Bach T, Muschter R, Sroka R, Gravas S, Skolarikos A, Herrmann TRW, Bayer T, Knoll T, Abbou CC, Janetschek G, Bachmann A, Rassweiler JJ. Laser treatment of prostatic obstruction: basic and physical differences. Eur Urol. 2012;61:317–25. An important review of the basic physical differences between the various laser wavelengths used in urology.PubMedCrossRef
4.
Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol. 1995;9(2):151–3.PubMedCrossRef
5.
McCulloch P, Taylor I, Sasako M, et al. Randomised trials in surgery: problems and possible solutions. BMJ. 2002;324(7351):1448–51.PubMedCrossRef
6.
Tubaro A, de Nunzio C. The current role of open surgery in BPH. EAU-EBU Update Series. 2006;4(5):191–201.CrossRef
7.
Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg. 2007;94(10):1201–8.PubMedCrossRef
8.
• Ahyai SA, Gilling P, Kaplan SA, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384–97. This meta-analysis of outcomes of transurethral procedures provides a good overview and comparison of the various techniques.PubMedCrossRef
9.
• Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011;107(7):1030–43. A comprehensive review with good sections on the learning curve and anti-coagulated patients.PubMedCrossRef
10.
Fitzpatrick JM. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Campbell-Walsh Urology, Vol 3, Chapter 88. 9th ed. Philadelphia: Elsevier; 2007.
11.
Madersbacher S, Lackner J, Brössner C, et al. Reoperation, Myocardial Infarction and Mortality after Transurethral and Open Prostatectomy: A Nation-Wide, Long-Term Analysis of 23,123 Cases. Eur Urol. 2005;47(4):499–504.PubMedCrossRef
12.
•• Gilling PJ, Wilson LC, King CJ, et al. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109(3):408–11. An important long-term follow-up to the most cited and original RCT comparing HoLEP to TURP. Confirms the excellent durability of HoLEP.PubMedCrossRef
13.
Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183(3):1105–9.PubMedCrossRef
14.
Marszalek M, Ponholzer A, Pusman M, et al. Transurethral Resection of the Prostate. Eur Urol Suppl. 2009;8(6):504–12.CrossRef
15.
Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53(1):160–6.PubMedCrossRef
16.
Gumus E, Boylu U, Turan T, Onol FF. The learning curve of robot-assisted radical prostatectomy. J Endourol. 2011;25(10):1633–7.PubMedCrossRef
17.
Sugiono M, Teber D, Anghel G, et al. Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). Eur Urol. 2007;51(5):1332–40.PubMedCrossRef
18.
Shah HN, Mahajan AP, Sodha HS, Hegde S, et al. Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol. 2007;177(4):1468–74.PubMedCrossRef
19.
Jeon SH, Han K-S, Yoo KH, et al. How many cases are necessary to develop competence for laparoscopic radical nephrectomy? J Endourol. 2009;12:1965–9.CrossRef
20.
Kaul S, Shah N, Menon M. Learning curve using robotic surgery. Current Urology Reports. 2006;7(2):125–9.PubMedCrossRef
21.
Schout BMA, Persoon MC, Martens EJ, et al. Analysis of pitfalls encountered by residents in transurethral procedures in master-apprentice type of training. J Endourol. 2010;24(4):621–8.PubMedCrossRef
22.
Long R, Connolly S, Sweeney P. Impact of pharmacotherapy on the incidence of transurethral prostatectomy for benign prostatic hyperplasia and the implications for surgical training. Ir Med J. 2010;103(9):281–2.PubMed
23.
Tan AHH, Gilling PJ, Kennett KM, et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170(4 Pt 1):1270–4.PubMedCrossRef
24.
• Ahyai SA, Chun FKH, Lehrich K, et al. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy—which procedure is faster? J Urol. 2012;187(5):1608–13. Addresses an important issue to the practicing urologist, that of operating time. HoLEP has traditional been said to be less efficient than other techniques which is not actually the case.PubMedCrossRef
25.
Kim SC, Matlaga BR, Kuo RL, et al. Holmium laser enucleation of the prostate: a comparison of efficiency measures at two institutions. J Endourol. 2005;19(5):555–8.PubMedCrossRef
26.
Ritter M, Krombach P, Bolenz C, et al. Standardized comparison of prostate morcellators using a new ex-vivo model. J Endourol. 2012;26(6):697–700.PubMedCrossRef
27.
Cornu J-N, Terrasa J-B, Lukacs B. Ex-vivo comparison of available morcellation devices during holmium laser enucleation of the prostate through objective parameters. J Endourol. 2012 Jun 4.
28.
EAU Guidelines, edition presented at the 25th EAU Annual Congress, Barcelona 2010. EAU Guidelines Office, Arnhem, The Netherlands ISBN 978-90-79754-70-0.
29.
Vora A, Mittal S, Hwang J, Bandi G. Robot-assisted simple prostatectomy: multi-institutional outcomes for glands larger than 100 grams. J Endourol. 2012;26(5):499–502.PubMedCrossRef
30.
Lee NG, Xue H, Lerner LB. Trends and attitudes in surgical management of benign prostatic hyperplasia. Can J Urol. 2012;19(2):6170–5.PubMed
31.
• Gerstein NS, Schulman PM, Gerstein WH, et al. Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome. Ann Surg. 2012;255(5):811–9. An overview of the effects of aspirin withdrawal, which consolidates a lot of what is known on the subject and gives some sensible guidelines.PubMedCrossRef
32.
Elzayat E, Habib E, Elhilali M. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol. 2006;175(4):1428–32.PubMedCrossRef
33.
Tyson MD, Lerner LB. Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol. 2009;23(8):1343–6.PubMedCrossRef
Metadata
Title
In 2013, Holmium Laser Enucleation of the Prostate (HoLEP) May Be the New ‘Gold Standard’
Authors
Simon van Rij
Peter J. Gilling
Publication date
01-12-2012
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 6/2012
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-012-0279-4

Other articles of this Issue 6/2012

Current Urology Reports 6/2012 Go to the issue

Benign Prostatic Hyperplasia (K McVary, Section Editor)

LUTS and Sleep Disorders: Emerging Risk Factor

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Self-Report Measurement of Lower Urinary Tract Symptoms: A Commentary on the Literature Since 2011

Office Urology (N Shore, Section Editor)

Male Genital Premalignant Dermatoses

Office Urology (N Shore, Section Editor)

A Reappraisal of Storage and Voiding Dysfunction

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Testosterone Replacement Therapy and Prostate Health

Benign Prostatic Hyperplasia (K McVary, Section Editor)

The Impact of Prostate Biopsy on Urinary Symptoms, Erectile Function, and Anxiety