Cost Savings Achieved through Introduction of Holmium Laser Enucleation of the Prostate (HOLEP) (original) (raw)
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Holmium Laser Enucleation of the Prostate (HoLEP): A Technical Update
World journal of surgical oncology, 2003
INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve. TECHNICAL CONSIDERATIONS: Detailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue. CONCLUSIONS: HoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior...
International braz j urol, 2016
ARTICLE INFO ______________________________________________________________ ______________________ Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Q max values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05. Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Q max values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up. Conclusions: HoLEP improved IPSSs, Q max values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.
Holmium Laser Enucleation of the Prostate: A Comparison of Efficiency Measures at Two Institutions
Journal of Endourology, 2005
To compare the immediate postoperative outcomes of patients with benign prostatic hyperplasia undergoing Holmium laser enucleation of the prostate (HOLEP) with and without full anticoagulation or antiplatelet therapy at the time of surgery. Materials and Methods: A retrospective review was performed on a series of consecutive patients undergoing HOLEP at our institution by a single surgeon from February 2004 to September 2010. Demographic, surgical, pathological and outcome data were collected. Two cohorts were identified on the basis of antithrombotic therapy at the time of surgery. Patients who continued on aspirin, aspirin/dipyridamole, clopidogrel and warfarin throughout the surgery were included in the antithrombotic cohort. Univariate analysis was performed to determine differences in outcomes between the 2 cohorts. Results: Total 125 consecutive patients underwent HOLEP with 52 patients on antithrombotic therapy at the time of surgery and 73 patients were not on antithrombotic therapy during surgery. Patients in the antithrombotic group were older (75.1 ±7.5 vs. 71.7 ± 8.3 years; p = 0.02) and had a higher median ASA physical
European Urology, 2008
e u r o p e a n u r o l o g y 5 3 ( 2 0 0 8 ) 1 6 0 -1 6 8 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objectives: To report 5-year follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with open prostatectomy (OP). Methods: One hundred twenty patients with prostates greater than 100 g in weight according to transrectal ultrasound were randomised to either the HoLEP or the OP group (ie, 60 patients to each group). Preoperative and postoperative assessments included American Urological Association Symptom Score (AUA-SS), maximum urinary flow rates (Q max ), and postvoid residual urine (PVRU) volumes. Measurements were performed at 1, 3, 6, 12, 18, 24, 36, 48, and 60 mo. Postoperative outcome data were compared. All complications were recorded. Results: Five years postoperatively, a total of 46 patients (38.3%) were lost to follow-up or had to be excluded from the study. All the remaining 74 patients (42 HoLEP vs. 32 OP patients, p = 0.11) had undergone the 5-yr follow-up assessments. Mean AUA-SS was 3.0 in both groups ( p = 0.98), mean Q max was 24.4 ml/s in both groups ( p = 0.97) and PVRU volume was 11 ml in the HoLEP and 5 ml in the OP group ( p = 0.25). Late complications consisted of urethral strictures and bladder-neck contractures; reoperation rates were 5% in the HoLEP and 6.7% in the OP group ( p = 1.0). No patient developed benign prostatic hyperplasia recurrence. Conclusions: Five years after the operation, the improvements in micturition obtained with HoLEP and OP were equally good, and reoperation rates similarly low. HoLEP seems to be a true endourological alternative to OP.
Holmium laser enucleation of the prostate: A size-independent new “gold standard”
Urology, 2005
We report our experience with holmium laser enucleation of the prostate (HoLEP) for treatment of 552 patients with symptomatic benign prostatic hyperplasia (BPH) and their long-term outcome. Between March 1998 and January 2005, a retrospective review was conducted at our institution of 552 cases in which patients underwent HoLEP. Patient characteristics, indications for surgery, preoperative and postoperative International Prostate Symptom Score (I-PSS), peak flow rate (Q max), postvoid residual urine, operative data, catheterization time, hospital stay, and immediate and long-term complications were recorded. The mean age of patients was 73.7 Ϯ 7.9 years, and the mean follow-up time was 36 months. The mean preoperative prostate size was 83.7 Ϯ 49.7 cm 3 (range, 20 to 351 cm 3), the mean enucleation time was 86 minutes (range, 15 to 255 minutes), and the mean enucleated tissue weight was 52.1 Ϯ 43.7 g (range, 5 to 340 g). The voiding parameters were significantly improved, with a 200% increase in Q max , as well as a 75% improvement in I-PSS at 1 year postoperatively, which continued to improve during subsequent follow-up. A total of 11 patients required blood transfusion; 8 of them were on anticoagulant therapy. Irritative symptoms were noted in 9.4% and transient stress incontinence in 4.2% of patients. Bladder neck contracture and urethral stricture each developed in 1.3% of patients. We conclude that HoLEP is a safe and effective procedure for treatment of symptomatic BPH, regardless of prostate size, with low morbidity and short hospital stay. HoLEP appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy, and it may be considered a size-independent new "gold standard." UROLOGY 66
Urology, 2006
Objectives. To compare the cost of open transvesical prostatectomy (OP) with that of holmium laser enucleation (HoLEP) in the treatment of bladder outlet obstruction (BOO) attributed to benign prostatic hyperplasia. Methods. From February to May 2004, 63 consecutive patients with symptomatic benign prostatic hyperplasia in a large prostate (70 to 220 g) and documented BOO were randomized to surgical treatment with OP (29 in group 1) or HoLEP (34 in group 2). All costs associated with the procedures during the hospital stay were recorded prospectively, and a cost-effectiveness analysis of the critical perioperative (ie, intraoperative and postoperative to hospital discharge) data was performed. Results. The cost analysis showed a mean perioperative cost of €2868.9 ($3556.3) for group 1 and €2356.5 ($2919.4) for group 2. A direct comparison analysis showed that the most significant cost factors were the operative time (average 16.1% and 25.1% to the cost of OP and HoLEP, respectively), operating room surgical setup/disposables, including laser fiber and resectoscope loop in group 2 (average 13.3% and 29.3% to the cost of OP and HoLEP, respectively), and length of postoperative hospital stay (average 53.3% and 32.0% to the cost of OP and HoLEP, respectively). Overall, the hospitalization cost of HoLEP was 9.6% less than that for OP.
European Urology Supplements, 2006
A prospective, randomised study comparing outcomes and 2-year follow-up (FU) between holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for the treatment of benign prostatic hyperplasia (BPH) of prostates >/= 70 gr. MATERIAL & METHODS: From March 2003 to December 2004, 80 consecutive patients with symptomatic BPH were randomised to be treated surgically either with HoLEP (group 1, n = 41) or standard OP (group 2, n = 39). Patients of both groups were pre-operatively assessed by: scoring of subjective symptoms with International Prostate Symptom Score (I-PSS) and Quality of life (QoL) questionnaires; physical exam, including digital rectal examination, total serum PSA, kidney-bladder and trans-rectal prostatic (TRUS) ultrasonography. Peri-and post-operative parameters were also carefully assessed. Patients were evaluated at 3-, 12and 24-month FU with the same questionnaires, free urofl owmetry and complete urodynamic multichannel evaluation. RESULTS: : Group 1 vs. group 2: mean±SE pre-operative TRUS volume of the prostates: 108.15 +/= 30.5 gr and 116.7 +/= 24.02 gr (p = 0.33); volume of the adenoma: 75.8 +/= 34.5 gr and 82.5 +/= 4.5 gr (p = 0.41), respectively. Pre-operative total PSA values: 5.8 +/= 3.01 ng/dl vs. 6.9 +/= 2.89 ng/dl (p = 0.29); mean weight of the specimens: 28.3 +/= 3.3 gr vs. 32.6 +/= 2.04 gr (p = 0.005). Surgical time was overall longer in the group 1 (62.9 +/= 18.3 vs. 53.5 +/= 11.5 mins; p = 0.06), whilst catheter removal (1.5 +/= 1.07 vs. 4.1 +/= 0.5 days) and hospital stay (2.7 +/= 1.07 vs. 5.4 +/= 1.05 days; p < 0.001) were signifi cantly shorter in groups 1 as compared with group 2. Day-1 post-operative hemoglobin levels: 12.3 +/= 1.8 vs. 11.1 +/= 1.64 g/dl (p = 0.04). Twelve patients from group 2 required blood transfusion compared to 4 from group 1 (p < 0.07). Seventy-eight and 40 patients were available at the 12-and 24-month FU, respectively. No statistical difference was seen between the two groups at urofl owmetry, IPSS and QoL at the 12-and 24-month FU, respectively. Furthermore, in both groups urodynamic fi ndings showed an improvement and durability in terms of relief of obstruction at the 24-month FU. All cases of mild stress incontinence in both groups were resolved at the 12-month FU. One patient in both groups required endoscopic reintervention for urethral stricture/bladder neck sclerosis, at the 24-month FU. Five patients (2 from group 1 and 3 from group 2) were lost to 24-month FU. CONCLUSIONS: HoLEP for treatment of BPH with prostates >70 gr is a feasible technique guaranteeing similar results to OP after 24-month FU. Furthermore, the reduction in catheterization, hospital stay and blood loss make HoLEP an attractive endourologic option for the treatment of large prostates.
Journal of Lasers in Medical Sciences, 2011
Introduction: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate. Materials and Methods: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated. Results: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study's results in favor of the new techniques. Conclusion: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation. Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments.