Holmium Laser Enucleation of the Prostate: A Modified Enucleation Technique and Initial Results

Purpose: Although holmium laser enucleation of the prostate has been proven to be an excellent technique for the treatment of benign prostatic hyperplasia, it has not been widely applied due to technical difficulties and longer operative time. We modified the current technique of enucleation and present our initial experience. Materials and Methods: A total of 189 patients with benign prostatic hyperplasia underwent prostatectomy with our modified technique for holmium laser enucleation of the prostate. Intraoperative and postoperative data were prospectively collected. For followup International Prostate Symptom Score, quality of life, maximal flow rate and post-void residual urine were recorded. Results: Mean +/- SD preoperative prostate volume was 78.1 +/- 24.3 cc and 60.9 +/- 39.2 gm tissue were enucleated. Mean operative and enucleation times were 54.7 +/- 21.1 and 36.5 +/- 16.3 minutes, respectively. Mean serum hemoglobin decrease was 0.98 +/- 0.72 gm/dl. Mean catheter time was 1.2 +/- 0.5 days and mean postoperative hospital stay was 4.9 +/- 3.4 days. Serious complications were not observed. Three patients complained of transient stress incontinence which resolved within 3 months. Significant improvement occurred in International Prostate Symptom Score, quality of life, maximal flow rate and post-void residual urine volume at 3 and 6-month followup compared with the preoperative baseline. Conclusions: The modified holmium laser enucleation of the prostate technique is effective and safe when treating benign prostatic hyperplasia.