Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience

Hazem Elmansy; Amr Hodhod; Moustafa Fathy; Philippe D Violette; Ahmed Elshafei; Ahmed S Zakaria; Ryan Kelly; Radu Rozenberg; Amer Alaref; Loay Abbas; Ruba Abdul Hadi; Ahmed Kotb; Walid Shahrour

doi:10.1007/s00345-023-04292-4

Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience

World J Urol. 2023 Mar;41(3):805-811. doi: 10.1007/s00345-023-04292-4. Epub 2023 Jan 28.

Authors

Affiliations

¹ Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada. hazem.mansy@rocketmail.com.
² Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada.
³ Urology Department, Menoufia University, Shebin Elkom, Egypt.
⁴ Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁵ Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.

PMID: 36708378
DOI: 10.1007/s00345-023-04292-4

Abstract

Introduction: Refractory hematuria secondary to prostatic disease typically resolves with conservative management; however, this condition may require hospitalization with extensive measures to control life-threatening bleeding. The aim of this study was to report our experience using holmium laser enucleation of the prostate (HoLEP) as an emergency treatment in this clinical setting.

Methods: We conducted a retrospective review of all patients that presented to the emergency department with refractory hematuria of prostatic origin from October 2017 to September 2021, for whom hospitalization and conservative management failed to control bleeding. All emergency HoLEP procedures were performed by a single surgeon. Preoperative and intraoperative parameters, as well as perioperative outcomes, were collected and analyzed. Postoperative outcomes included duration of foley catheterization, length of postoperative hospital stay, and hospital readmissions.

Results: A total of 40 emergency HoLEP procedures were performed. Our cohort had a median prostate volume of 110.5 cc and a median resected weight of 81 g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications on admission. The urethral catheter was removed within 1 day in 95% of patients with a successful trial of void (TOV). Moreover, 92.5% of patients were discharged home within 24 h of their procedure. Two patients (5%) experienced clot retention within one-week post-discharge with a 2.5% overall readmission rate. All postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual volume (PVR), showed significant improvement at 1 year follow up.

Conclusion: Our experience demonstrates that emergency HoLEP is an effective treatment option for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.

Keywords: Benign prostatic hyperplasia; Enucleation; Laser.

MeSH terms

Aftercare
Hematuria / etiology
Hematuria / surgery
Holmium
Humans
Laser Therapy* / methods
Lasers, Solid-State* / therapeutic use
Male
Patient Discharge
Prostate / surgery
Prostatic Hyperplasia* / complications
Prostatic Hyperplasia* / diagnosis
Prostatic Hyperplasia* / surgery
Quality of Life
Retrospective Studies
Transurethral Resection of Prostate* / methods
Treatment Outcome

Substances

Holmium