MP45-02\u2003PERIOPERATIVE OUTCOMES FOR MASSIVE GLAND BENIGN PROSTATIC HYPERPLASIA (> 200CM3) TREATED WITH HOLMIUM LASER ENUCLEATION OF THE PROSTATE

Abstract

INTRODUCTION AND OBJECTIVES: Patients with massive gland benign prostate hyperplasia (BPH) pose a unique challenge to urologists. We present our experience with HoLEP for glands greater than 200 cm3. METHODS: An IRB-approved prospective database has been maintained since 2007 for all HoLEP procedures. All patients with preoperative gland size >200cm3 who underwent HoLEP between 2007 and 2018 were analyzed. Subgroup analysis was performed comparing prostate size 200-299 cm3 versus >300cm3. Univariate analysis using Kruskal Wallis and Fisher exact tests to determine predictors of outcomes was done. RESULTS: Seventy eight patients underwent HoLEP for glands >200cc3. Mean preoperative gland size was 255.9 cm3, and a mean of 157.2g was resected on final pathology. Mean enucleation time was 77 minutes, and mean morcellation time was 50.8 minutes. Patients stayed a mean of 1.8 days and had a catheter for a mean of 2.7 days. No patients were catheter dependent at last follow up. On subgroup analysis, comparing patients with preoperative gland size 200-299cc3 vs >300cc, there was no difference in mean operative time (169.8 min vs 174.5 min, p=0.59) or mean enucleation time (77.4 min vs 81.3 min, p=0.635). There was a significant difference in morcellation time (48.1 min vs 73.7 min, p=0.045) and enucleation efficiency (3.4 cm3/min vs 4.7 cm3/min). No significant difference was seen in length of hospital stay (1.8 vs 2 days, p=0.52) and mean duration of postoperative catheterization (2.7 vs 3 days, p=0.74). CONCLUSIONS: HoLEP provides a safe and efficient treatment option for patients who have massive gland BPH >200cm3. There was no difference in overall procedure time or enucleation time with increasing gland size, supporting previously published studies that HOLEP is a size independent intervention. There is an expected difference in morcellation time. This represents the largest series of massive gland BPH treated in the contemporary literature and suggests HoLEP should be considered as a first line treatment for these patients. Source of Funding: None