Can a low power holmium laser enucleate large prostates? Operative & patient outcome data for 132 50-watt HoLEPs in Prostates > 75cc from a single centre
BAUS ePoster online library. Khan F.
Jun 27, 2018; 211362
Disclosure(s): I have received and continue to receive honorariums from Boston Scientific for mentoring and consulting services and for attendance at international meetings. I have also in the past received an educational grant from Karl Storz.
Mr. Farooq Khan
Mr. Farooq Khan
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Abstract
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Introduction: Most HoLEPs are performed by high powered lasers (100 & 120 Watt (W)). Many agree lower power can enucleate successfully. Debate continues on whether a 50 W laser can enucleate large prostates. We present outcome data from 132 large prostates using a low power holmium laser.

Method: Two HoLEP naïve surgeons completed 393 HoLEPs using a 50W holmium laser (Auriga XL, Boston Scientific Inc., Piranha morcellator, Richard Wolf). 132 of these were greater than 75cc (range 76-240cc). Pre and post-operative flow rate (Qmax), residual volume (RV), prostate symptom score (IPSS), quality of life score (QoL), enucleation/total operating times, hospital stay, histology, haemoglobin (Hb) and catheter times were accurately recorded.

Results: SAS statistical software v 9.3 paired t-test and non-parametric Wilcoxon signed-rank test. Mean age 72.7, mean TRUS volume 108.7cc, 64.4% retention cases. Mean enucleated weight 69.4g (95% CI 63.87,74.86), mean operating room time (enucleation & morcellation) 109.5mins (95% CI 102.18,116.83) with an enucleation rate of 1.01 g/min (95% CI 0.91,1.10). Mean IPSS fell 14.26 points (95% CI -17.22, -11.30 p<0.0001), QoL scores improved 3.46 (95% CI -4.11,-2.80 p<0.0001), mean Qmax improved 20.3 ml/s (95% CI 14.41,26.13 p<0.0001). Mean hospital stay 1.11 days (95% CI 0.97,1.24), mean Hb reduction of 2.09 g/L (95% CI -2.30,-1.88, p<0.0001). Stricture rate 2.3%, bladder neck contracture rate 2.3%. All patients rendered catheter free. Two transfusions recorded. Cancer detection 7.6%.

Conclusion: Low power holmium lasers can enucleate large prostates with excellent clinical outcomes supporting its use as a cost-effective manner to deliver a HoLEP service.
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