18 years of holmium laser enucleation of the prostate: A single center experience

Purpose: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. Materials and Methods: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. Results: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). Conclusions: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.