Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup

Abstract

Purpose: We assessed the long-term durability of subjective and objective outcomes and complication rates after holmium laser enucleation of the prostate.

Materials and methods: We conducted a retrospective analysis of 949 evaluable patients treated with holmium laser enucleation of the prostate between March 1998 and September 2010 at a single center. Study variables included International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume and prostate specific antigen.

Results: Mean followup was 62 months. Mean preoperative post-void residual volume, maximal flow rate, International Prostate Symptom Score and quality of life were 311 ml, 7.9 ml per second, 19 and 3.8, respectively. Postoperatively all variables showed significant improvement starting at month 1 of followup and remained improved for the entire followup period. Patients with acute urinary retention represented 36% (343) of the cohort. Postoperative mean post-void residual volume was 45, 25.7 and 52 ml, mean maximal flow rate was 21.5, 24.3 and 23.4 ml per second, mean International Prostate Symptom Score was 7.3, 4.4 and 3.8, and mean quality of life was 1.7, 1 and 0.7 at 1 month, 1 year and 10 years, respectively. Persistent urge and stress incontinence were found in 1% and 0.5% of patients, respectively. Bladder neck contracture, urethral stricture and reoperation due to residual adenoma developed in 0.8%, 1.6% and 0.7% of patients.

Conclusions: Holmium laser enucleation of the prostate represents an effective treatment modality for men with symptomatic benign prostatic hyperplasia with a low rate of complications during a long followup. Patients who experience improvement from baseline to early followup maintain improvement at later followup.