Median lobe vs. complete gland holmium laser enucleation of the prostate

A propensity score matching

Authors

  • Amihay Nevo University Hospitals Cleveland Medical Center - Urology Institute
  • Scott M. Cheney Mayo Clinic Arizona - Department of Urology
  • Michael Callegari University Hospitals Cleveland Medical Center
  • Jonathan P. Moore Mayo Clinic Arizona - Department of Urology
  • Karen L. Stern Mayo Clinic Arizona - Department of Urology
  • Michael A. Zell University Hospitals Cleveland Medical Center - Urology Institute
  • Haidar Abdul-Muhsin Mayo Clinic Arizona - Department of Urology
  • Mitchell R. Humphreys Mayo Clinic Arizona - Department of Urology

DOI:

https://doi.org/10.5489/cuaj.7890

Keywords:

BPH, LUTS, HoLEP, enucleation, partial

Abstract

Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting aging men. While holmium laser enucleation of the prostate (HoLEP) is one of the most effective treatments for BPH, variations of the procedure, such as median lobe HoLEP (MLHoLEP), are rarely reported. Here, we report our institution’s experience with partial HoLEP.

Methods: Our institutional prospective database was queried for patients having undergone median or individual lateral lobe enucleation between 2007 and 2018. A control cohort of patients who underwent standard HoLEP (sHoLEP) was identified using 1:2 propensity score matching based on age, prostate size, maximal flow rate (Qmax), postvoid residual volume (PVR), and American Urological Association symptom score (AUAss). Three and 12-month AUAss, PVR, and Qmax were compared.

Results: Forty-seven patients were identified as having undergone MLHoLEP. At three-month followup, AUAss (p<0.01) and incontinence rates (p=0.045) were lower for MLHoLEP patients, in addition to them having shorter operative (36.5 mins vs. 64.5 mins, p<0.01) and enucleation (13.8 mins vs. 37 mins, p<0.01) times as compared to sHoLEP patients. No difference was noted between MLHoLEP and sHoLEP cohorts with respect to age, prostate volume, PVR, or Qmax. Significant improvement in AUAss, PVR, and Q max from baseline to three and 12 months was noted overall in both groups.

Conclusions: MLHoLEP could provide a surgical option with reduced operative time, quicker improvement in AUAss, and restored continence in appropriately selected patients. Ultimately, MLHoLEP represents a safe and effective treatment option to select patients who may not be eligible for or face potential morbidity concerns associated with sHoLEP.

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Published

2022-08-30

How to Cite

Nevo, A., Cheney, S. M., Callegari, M., Moore, J. P., Stern, K. L., Zell, M. A., Abdul-Muhsin, H., & Humphreys, M. R. (2022). Median lobe vs. complete gland holmium laser enucleation of the prostate : A propensity score matching. Canadian Urological Association Journal, 17(1), E39–43. https://doi.org/10.5489/cuaj.7890

Issue

Vol. 17 No. 1 (2023): CUAJ January

Section

Original Research

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