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Ye OD, Tadrist A, Di Crocco E, Karsenty G, Toledano H. [Urinary incontinence after endoscopic enucleation of the prostate with the Holmium laser: Evolutionary aspects and associated predictive factors]. Prog Urol 2023; 33:198-206. [PMID: 36424230 DOI: 10.1016/j.purol.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the evolutionary aspects of stress urinary incontinence and urinary incontinence by urgency after HoLEP through a series of 200 consecutive cases of the same surgeon then to seek secondarily the predictive factors of occurrence in the service of urology of the Hospital Center of Martigues. PATIENTS AND METHODS This was a monocentric, retrospective, descriptive and analytical study conducted in the urology department of the Martigues Hospital. All patients who were treated with HoLEP for benign prostatic hypertrophy (BPH) between September 2017 and March 2021 were included in the study. Patients with an age greater than 75 years, obese (BMI>30) or with neurological disease were excluded from this study. RESULTS Between September 2017 and March 2021, 204 patients were included in our study. The average urinary incontinence rate was 21.2% 12.2% 7.4% and 2.7% at 1 month, 3 months, 6 months and 12 months respectively. The rate of stress urinary incontinence was 5.4%, 9.2%, 5.6% and 1.8% at 1 month, 3 months, 6 months and 12 months post HoLEP respectively. Urge urinary incontinence was estimated at 13.3%, 3%, 1.8% and 0.9% at M1, M3, M6 and M12 post-HoLEP respectively. Preoperative erectile dysfunction, delivered energy, enucleated prostate weight and total intraoperative time were statistically associated with the occurrence of stress urinary incontinence postoperatively. The operative time and a low operative Qmax were statistically associated with the occurrence of postoperative stress urinary incontinence. CONCLUSION HoLEP is at risk of postoperative urinary incontinence. Preoperative information of the patients on the risk of urinary incontinence is essential.
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Affiliation(s)
- O D Ye
- Service d'urologie, centre hospitalier de Martigues, Martigues, France.
| | - A Tadrist
- Service d'urologie, centre hospitalier de Martigues, Martigues, France
| | - E Di Crocco
- Service d'urologie, centre hospitalier de Martigues, Martigues, France
| | - G Karsenty
- Service d'urologie, centre hospitalier universitaire de Marseille la Conception, Marseille, France
| | - H Toledano
- Service d'urologie, centre hospitalier de Martigues, Martigues, France
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2
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Michaud C, Codas-Duarte R, Matillon X, Crouzet S, Badet L, Fassi-Fehri H. One-year Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introduction of a Composite Score (Hexafecta). Prog Urol 2021; 32:189-197. [PMID: 34656450 DOI: 10.1016/j.purol.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficiency (micturition symptoms, continence, erection) and safety of Holmium Laser Enucleation of the Prostate (HoLEP) with a single composite score (the Hexafecta score) one year postprocedure. PATIENTS AND METHODS We conducted a single-center retrospective study including all patients who had undergone HoLEP for the treatment of benign prostate hyperplasia (BPH) between May 2013 and August 2017. Data were obtained preoperatively and at the 6- and 12-month visits. We also reported all 90-day complications. The Hexafecta score included 6 criteria: peak urine flow of at least 15ml/s, 30% reduction in International Prostate Symptoms Score (IPSS) score, quality of life via the IPSS less than 2, no incontinence (International Consultation Incontinence Questionnaire), no significant change in erectile function (International Index of Erectile Function), and no grade III or more complications according to the Clavien-Dindo classification. RESULTS Two hundred thirty-five patients were included, of whom 197 (83.8%) completed the 12-month visit. Complete data were available to assess the Hexafecta score for 178 of them (75.7%). Most of the missing data were for uroflowmetry and the erectile function assessment. Hundred three patients (58%) met all 6 criteria, while 45 (25%) met 5 of them. None were retreated for BPH in the follow-up period. The de novo incontinence rate was 4.1%. CONCLUSION The Hexafecta score is a simple, transversal method for comprehensively evaluating functional outcomes after HoLEP surgery. Such an evaluation could be used to compare other types of procedures for BPH treatment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- C Michaud
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France.
| | - R Codas-Duarte
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - X Matillon
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - S Crouzet
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - L Badet
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - H Fassi-Fehri
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
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Undie CU, Nnana EI, Torporo KR. Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world.
Methods
A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented.
Results
There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis.
Conclusions
The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.
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Gómez-Sancha F. The constant search for the greater good: evolving from TURP to anatomic enucleation of the prostate is a safe bet. World J Urol 2021; 39:2401-2406. [PMID: 33625568 DOI: 10.1007/s00345-021-03637-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In a troubling moment in history with an ongoing world pandemic and the impending economic crises, there is today a plethora of commercially available options for the minimally invasive treatment of BPH. New industry-driven evaluation criteria of these treatments, the logical marketing hype, a short follow-up for many of them, make challenging to interpret the role they will finally adopt in the armamentarium to treat BPH. METHOD The author comments on recently published literature based in own experience and insight. RESULTS AND CONCLUSIONS In this situation, choosing to evolve from TURP to the next step of endoscopic treatment, the size-independent anatomic endoscopic enucleation of the prostate is a safe bet. It is now exceedingly feasible when the paradigm of AEEP has changed, due to better learning opportunities and technological and surgical technique modifications that have refined this procedure significantly since its inception.
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Tunc L, Yalcin S, Kaya E, Gazel E, Yılmaz S, Aybal HC, Yılmaz M, Tokas T. The "Omega Sign": a novel HoLEP technique that improves continence outcomes after enucleation. World J Urol 2021; 39:135-141. [PMID: 32193652 DOI: 10.1007/s00345-020-03152-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Holmium-laser enucleation of the prostate (HoLEP) has been a promising prostate surgery since its first introduction. Although there are 10 different HoLEP techniques in the literature, stress urinary incontinence (SUI) is common, because surgery is not performed based on the topographic anatomy of the external sphincter. We have developed a new HoLEP method named as the ''Omega Sign technique", which is based on the topographic anatomy of the external sphincter and could provide better continence outcomes by decreasing SUI rates. MATERIALS AND METHODS The data of 400 patients who underwent HoLEP by a single surgeon between May 2016 and February 2019 were retrospectively reviewed. The patients were divided into two groups, the first underwent the Gilling's technique (Group 1) and the second the novel ''Omega Sign'' technique (Group 2). Continence status and post-micturition symptoms (PMS) were evaluated according to the standards recommended by the international continence status. RESULTS The data of 400 HoLEP procedures between May 2016 and February 2019 were analyzed, comparing Group 1 (n = 200) and Group 2(n = 200). SUI rate was significantly lower in Group 2 at the day of catheter removal and first month (p < 0.005). In addition, urge urinary incontinence (UUI) rate and PMS were significantly lower in Group 2. CONCLUSIONS We could demonstrate improved continence results, comparable functional outcomes and equally minimal complications with the standard HoLEP technique. We believe that, the novel 'Omega sign' technique decreases SUI rates and will become standardised and easy to understand, thereby bringing and creating a shorter learning curve.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Serdar Yalcin
- Department of Urology, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey.
| | - Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Sercan Yılmaz
- Department of Urology, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Halil Cagri Aybal
- Department of Urology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T, Hall in Tirol, Austria
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Kleinguetl C, Virani S, Bird ET, El Tayeb MM. Safety and efficacy of male urethral slings for management of persistent stress urinary incontinence after holmium laser enucleation of the prostate. Proc (Bayl Univ Med Cent) 2020; 33:554-556. [PMID: 33100527 DOI: 10.1080/08998280.2020.1778976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Holmium laser enucleation of the prostate gland (HoLEP) is an alternative to the traditional transurethral resection of the prostate, especially for large-volume prostates. One complication is urinary incontinence, which is usually stress urinary incontinence (SUI). Little data exist on surgical interventions for SUI after HoLEP. This retrospective case series examined the safety and possible efficacy of a midurethral sling (MUS) following HoLEP. Between January 2016 and February 2019, 610 HoLEPs were performed at our institution. Three (0.5%) had persistent, overly bothersome symptoms of SUI. All three underwent MUS placement with a transobturator AdVance® male sling after failed pelvic floor rehabilitation. The degree of SUI was evaluated by pad use pre-HoLEP, post-HoLEP, and post-MUS placement. Surgical times for HoLEP and MUS were evaluated. No patients were using pads for incontinence before HoLEP. The average pad use was 7 post-HoLEP and 0.3 post-MUS. The average morcellated prostate was 48 g, and surgical time was 68 min (52 for enucleation and 15 for morcellation). No complications were reported with MUS placement intraoperatively or postoperatively. MUS for persistent and bothersome SUI after HoLEP shows promise as a safe and effective surgical option.
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Affiliation(s)
- Colin Kleinguetl
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Shohaib Virani
- College of Medicine, Texas A&M Health Science Center, Temple, Texas
| | - Erin T Bird
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Marawan M El Tayeb
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
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Gudaru K, Gonzalez Padilla DA, Castellani D, Tortolero Blanco L, Tanidir Y, Ka Lun L, Wroclawski ML, Maheshwari PN, Figueiredo FCAD, Yuen‐Chun Teoh J. A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists. Andrologia 2020; 52:e13717. [DOI: 10.1111/and.13717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kalyan Gudaru
- Department of Urology University Hospitals of North Midlands NHS Trust Stoke‐on‐Trent UK
| | | | | | | | - Yiloren Tanidir
- Department of Urology Marmara University School of Medicine Istanbul Turkey
| | - Lo Ka Lun
- S.H. Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein São Paulo Brazil
- BP ‐ A Beneficência Portuguesa de São Paulo São Paulo Brazil
| | | | | | - Jeremy Yuen‐Chun Teoh
- S.H. Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China
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8
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Lee HY, Cho SY, Juan YS, Teoh JYC. How to optimise urinary continence in anatomical endoscopic enucleation of the prostate? Andrologia 2020; 52:e13621. [PMID: 32400034 DOI: 10.1111/and.13621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The traditional transurethral resection of the prostate (TURP) is considered as gold-standard surgical treatment to relieve symptoms resulting from bladder outlet obstruction by prostate enlargement. However, with the advances of novel laser technologies and more experienced surgeon conquering the steep learning curve, anatomical endoscopic enucleation of prostate (AEEP) has become a more popular alternative surgical technique. Although AEEP has compatible functional outcome, less blood loss, shorter catheterisation duration and hospital stay, the risk of post-operative urinary incontinence (UI) is often an issue of concern. In this review, we focus on discussion about risk factors related to increased incidence of UI, some surgical tips to avoid damaging external urinary sphincter and treatment strategies to facilitate recovery of urinary continence after surgery.
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Affiliation(s)
- Hsiang Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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9
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Figueiredo FCA, Cracco CM, Marins RL, Scoffone CM. Holmium laser enucleation of the prostate: Problem‐based evolution of the technique. Andrologia 2020; 52:e13582. [DOI: 10.1111/and.13582] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
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10
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Wei Y, Ke ZB, Xu N, Xue XY. Complications of anatomical endoscopic enucleation of the prostate. Andrologia 2020; 52:e13557. [PMID: 32147865 DOI: 10.1111/and.13557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 12/31/2022] Open
Abstract
Transurethral resection of the prostate (TURP) remains the 'gold standard' for surgical treatment of benign prostatic obstruction (BPO). Recently, anatomical endoscopic enucleation of the prostate (AEEP) using holmium laser, thulium laser and plasma, etc., is extensively applied in clinical practice. However, perioperative complications of AEEP are inevitable in spite of lower incidence compared with TURP. This study reviewed the literature related to the aetiology, prevention and treatment of common complications of AEEP, which would contribute to the diagnosis and treatment of BPO.
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Affiliation(s)
- Yong Wei
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Cornu JN. Hyperplasie bénigne de la prostate et incontinence urinaire. Prog Urol 2020; 30:3S10-3S20. [DOI: 10.1016/s1166-7087(20)30194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Yalçın S, Yılmaz S, Gazel E, Kaya E, Aydoğan TB, Aybal HÇ, Tunç L. Holmium laser enucleation of the prostate for the treatment of size-independent BPH: A single-center experience of 600 cases. Turk J Urol 2020; 46:219-225. [PMID: 32053095 DOI: 10.5152/tud.2020.19235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Holmium laser enucleation of the prostate (HoLEP) is an endourologic minimal invasive intervention of benign prostate hyperplasia (BPH). The interest on HoLEP is increasing in the literature. The aim of the present study was to evaluate the learning curve and our preliminary results. MATERIAL AND METHODS A retrospective analysis on 600 patients with BPH who underwent HoLEP between July 2015 and April 2019 was performed. Perioperative measures including enucleation efficiency (EE), morcellation efficiency (ME), and percentage of resected tissue weight (PRW) were recorded. Hospitalization time (HT) and catheterization time (CT) were measured. Functional outcomes, Clavien-Dindo classification complications, and continence status were assessed at 1-, 3-, and 6-month follow-up. RESULTS The mean age, prostate size, and prostate-specific antigen levels of the patients were 64.54 years, 91 g, and 4.54 ng/mL, respectively. There were 38.3% of patients with ≥100 g prostate size. The measured EE, ME, and PRW were 1.12 g/min, 4 g/min, and 72%, respectively. The mean HT and CT were 24.53 h and 21.50 h, respectively. Functional outcomes showed significant improvement at 1-, 3-, and 6-month follow-up. Intraoperative and postoperative complications were comparable with the literature. The most common perioperative complication was superficial bladder mucosal injury (n=8, 1.33%). Only one patient had persistent stress urinary incontinence at 6-month follow-up. CONCLUSION As mentioned in the literature, HoLEP indications are independent from prostate size. Our results showed similarity with the literature on functional outcomes, complication rates, and continence status. With its superior results, our HoLEP series from Turkey supports that HoLEP will replace transurethral resection of the prostate as the known current gold standard.
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Affiliation(s)
- Serdar Yalçın
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sercan Yılmaz
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Eymen Gazel
- Clinic of Urology, Acıbadem Ankara Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | | | - Lütfi Tunç
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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