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HOLMIUM LASER ENUCLEATION FOR PROSTATE ADENOMA GREATER THAN 100 GM.: : COMPARISON TO OPEN PROSTATECTOMY

2001; Lippincott Williams & Wilkins; Volume: 165; Issue: 2 Linguagem: Inglês

10.1097/00005392-200102000-00025

1527-3792

Jeffrey A. Moody, James E. Lingeman,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2001HOLMIUM LASER ENUCLEATION FOR PROSTATE ADENOMA GREATER THAN 100 GM.: : COMPARISON TO OPEN PROSTATECTOMY JEFFREY A. MOODY and JAMES E. LINGEMAN JEFFREY A. MOODYJEFFREY A. MOODY and JAMES E. LINGEMANJAMES E. LINGEMAN View All Author Informationhttps://doi.org/10.1097/00005392-200102000-00025AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Options for treatment of large (greater than 100 gm.) prostatic adenomas have until now been limited to open surgery or transurethral resection by skilled resectionists. Considerable blood loss, morbidity, extended hospital stay and prolonged recovery occur with open surgery for large prostatic adenomas. Endoscopic surgery for benign prostatic hyperplasia has evolved during the last decade to offer the patient and surgeon significant advantages of transurethral removal of prostatic adenomas. Holmium laser enucleation of the prostate with transurethral tissue morcellation provides significant reductions in morbidity, bleeding and hospital stay for patients with large prostate adenomas. Materials and Methods: A retrospective review of data on 10 cases of holmium laser enucleation and 10 open prostatectomies for greater than 100 gm. prostatic adenomas was performed from 1998 to 1999 at our institution. Patient demographics, indication for surgery, preoperative and postoperative American Urological Association (AUA) symptom scores, operating time, serum hemoglobin, resected prostatic weight, pathological diagnosis, length of stay and complications were compared. Results: Patient age, indications for surgery (retention, failed medical therapy, high post-void residual, bladder calculi, bladder diverticula and azotemia) and preoperative AUA symptom scores were similar in both groups. Postoperative AUA symptom scores were significantly decreased (p <0.004) in both groups. Operating times were not significantly different. Serum sodium was unchanged by holmium laser enucleation (not significant), and postoperative hemoglobin was not significantly reduced in the holmium laser enucleation group but decreased significantly in the open prostatectomy group (mean decrease 2.9 ± 0.7 gm., p = 0.0003). Resected weight was greater in the holmium laser enucleation group (151 versus 106 gm., p = 0.07). Length of stay was significantly shorter in the holmium laser enucleation group (2.1 versus 6.1 days, p <0.001). Complications in the holmium laser enucleation group included stress urinary incontinence in 4 cases, prostatic perforation in 1 and urinary retention in 1. No patient treated with holmium laser enucleation was discharged home with an indwelling catheter. Complications in the open prostatectomy group included bladder neck contractures in 2 cases, stress incontinence in 1 and urge incontinence in 1. All patients treated with open prostatectomy were discharged home with an indwelling catheter. Conclusions: Holmium laser enucleation is an effective, safe procedure for large prostatic adenomas with significantly lower morbidity, catheterization duration and length of stay. Performing holmium laser enucleation for large adenomas requires experience. Stress incontinence was seen frequently with laser but was short-term and self-limited. 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Volume 165Issue 2February 2001Page: 459-462 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.KeywordsholmiumprostatectomylasersprostateMetricsAuthor Information JEFFREY A. MOODY Financial interest and/or other relationship with Coherent. More articles by this author JAMES E. LINGEMAN Financial interest and/or other relationship with Coherent and BSC. More articles by this author Expand All Advertisement PDF downloadLoading ...