Minimally Invasive Surgery for Benign Prostatic Obstruction

New Insights and Future Technical Standards

Enrique Rijo; Richard Hindley; Shahin Tabatabaei; Thorsten Bach


Curr Opin Urol. 2021;31(5):461-467. 

In This Article

Outpatient Holmium Laser Enucleation of the Prostate Procedure With Same Day Catheter Removal

Holmium laser enucleation of the prostate (HoLEP) is one of the most studied surgical procedures in Urology. Since it was first described by Peter Gilling,[25] HoLEP has evolved not only in the technique but also in the technology, using high power lasers and pulse modulation technologies.[26,27]

Normally after the procedure patients are discharged in 24–48 h without catheter. Recently some authors have demonstrated that HoLEP is possible as an outpatient procedure in selected cases.

Krambeck et al.[28] reported a feasibility pilot study for same day catheter removal after HoLEP for patients not undergoing anticoagulation therapy and with prostates < 250 mL.

A high-power laser with Moses 2.0 optimized for BPH technology (Lumenis Ltd, Yoknaem, Israel) was used in all the procedures. Continuous bladder irrigation was employed postoperatively in all cases.

This was a retrospective study of 30 patients, median prostate volume of 81 mL (37–235 mL). 30% of patients had a catheter before the procedure.

The median enucleation time was 39.5 min, morcellation time 5 min and enucleated specimen weight was 52.5 g (33–81). 90% (27) of patients were same day catheter free after a median time of 4.9 h from the end of the procedure. No 90-day complications or surgical reinterventions were reported.

Functional outcomes: Median IPSS score was 5, QoL 1, PVR was 16 mL and PSA was 0.7 ng/dl.

Despite the fact that this is only a feasibility retrospective study with a small number of cases, it can still be considered a step forward in HoLEP's evolution into a truly minimally invasive outpatient catheter free procedure.

One of the known drawbacks of HoLEP is the steep learning curve and the high rate of ejaculatory dysfunction. Kim et al.[29] reported 76.9% of total anejaculation after HoLEP.