Name: surgical treatment for benign prostatic hyperplasia: holmium laser enucleation of the prostate (holep).
Uploaded: 2018-03-06T12:30:00
Description: Watch this Scientific Journal Video about Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP. at JoVE.com

The authors have nothing to disclose.

Ethical approval was obtained from the Ethics Committee of Shanghai Ninth People&#39;s Hospital and the written informed consent of each patient were obtained in our study.
1. Patients and Surgical Materials
Notes: Patients diagnosed with BPH and need surgical treatment in accordance with the European Association of Urology (EAU) guidelines can be included10. This surgical procedure requires experience and a long learning curve...

<ol>
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In this protocol, we introduce a procedure for the surgical treatment of BPH. HoLEP can be employed in daily clinical practice. As mentioned, the development of BPH surgery includes three landmarks. The first is the open surgery. Retropubic prostatectomy and suprapubic open prostatectomy have extensively been employed in the clinical setting for a long time. Despite this, the technique involves severe adverse side effects, which are often observed during the perioperative period. These side effects include hemorrhage, la...

Benign prostatic hyperplasia (BPH), which is hyperplasia of the prostate gland, occurs in elderly males. This condition starts at approximately 40 y old, and morbidity can reach 50%-60% for men in their 60s and 80%-90% for men in their 70s and 80s1. BPH causes progressive obstruction, lower urinary tract symptoms, retention and its complications, and even renal failure, all of which lower the quality of life of the elderly male. After medical therapy, surgical treatment is often used as the most efficient treatment for symptomatic BPH.
Various types of surgery have been developed to treat the symptoms of BPH, including the first open prostatectomy introduced in 18942 and transurethral endoscopic surgery (TURP) a century later. Since its development, TURP has been regarded as the gold standard to surgically alleviate prostate enlargement.
The holmium laser operates at a wavelength of 2120 nm, which is similar to that of the tissue water3, which induces vaporization of water. Tissue penetration reaches 0.4 mm, and coagulation can also be operated with it. The process was first introduced for BPH in 19944. In 1998, Peter Gilling used the device to perform enucleation application5. As proposed by Peter Gilling et al. in the 1990s4, holmium laser enucleation of the prostate (HoLEP) is used to treat BPH by combining the two earlier types of surgery, including the open enucleation and the TURP4. With the development of the hyperplasia process, the prostatic peripheral zone is compassed by the transitional zone (TZ) to form a so-called surgical capsule. HoLEP allows the removal of the hyperplasic part of the prostate, the TZ, which separates the prostate capsule. Thus, HoLEP, as the anatomical surgery, can enucleate the enlarged prostate zone from the formed separation between TZ and capsule. Compared with the traditional surgical method, HoLEP may be safer, more efficient, and thorough with durable outcomes. Compared with TURP, holmium reduced the duration, irrigation time, and catheter time of the procedure and shortened hospital stay.6,7,8 The technique can also be performed safely on patients who are on anticoagulant therapy or with bleeding disorders9. Though there are different kinds of procedures for HoLEP, the main procedure is the same as mentioned in the following. We also introduce our own experiences and the innovation for this method in order to make it easier to accept and shorten the learning curve. The procedure is particularly suitable for large prostates and those combined with bladder stones, given that the holmium laser can also be used for lithotripsy8. This article introduces this technique and the detailed procedure.

<table border="0" cellpadding="0" cellspacing="0" width="1069">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:260px;">holmium laser</td>
			<td style="width:205px;">Lumenis, USA</td>
			<td style="width:344px;"></td>
			<td style="width:260px;">PowerSuite 100W</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">mechanical morcellator</td>
			<td>Lumenis, USA</td>
			<td></td>
			<td>VersaCut</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">27Fr continuous flow resectoscope</td>
			<td>Storz, Tuttlingen, Germany</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

surgical treatment for benign prostatic hyperplasia: holmium laser enucleation of the prostate (holep).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

Retrospective data, collected from 2015 to 2016, were obtained from the clinical database of our department. A total of 100 patients treated for BPH were enrolled in the study. Perioperative outcomes were included: operation time (OT), hemoglobin decrease after surgery, Na+ variation, hospital stay duration, bladder irrigation duration and following-up data. Basic patient characteristics were also collected during our study. In addition, the catheterization time and hospitaliza...

Watch this Scientific Journal Video about Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP. at JoVE.com

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

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