120 Watts HoLEP versus 100 Watts HoLEP, a comparative multicentric study on efficacy and safety

Yasser Hussein 1, Angelo Porreca2, Antonio Tesone3, Domenico Taglialatela1, Raffaella Milesi1, Francesca Ceresoli1, Alessandro Del Rosso1, Ivano Vavassori1
  • 1 Ospedale Treviglio-Caravaggio - ASST Bergamo Ovest, U.O.C. Urologia (Treviglio)
  • 2 Policlinico Abano Terme - Presidio Ospedaliero Regione Veneto, U.O. Urologia (Abano Terme)
  • 3 Ospedale Classificato Moriggia Pelascini, U.O. Urologia (Gravedona)

Objective

Holmium Laser Enucleation of the prostate (HoLEP) was introduce in 1998 by Peter Gilling with the traditional 3 lobes technique. HoLEP technique diffusion is due to advantages such as the use of saline as irrigation fluid, less hemorrhagic risks than TURP, and can treat any prostate size.
The introduction of more powerful lasers has allowed to treat larger prostate volumes.
Holmium:yttrium-aluminum-garnet (Ho:YAG) lasers doubled their power since the HoLEP was introduced.
Currently there is a lack in scientific literature of evidence in patients benefits and procedure’s outcome due to the increase in laser’s power up to 120 W.
This study compare the efficacy and safety between two Ho:YAG lasers, 120-W and 100-W, in perform HoLEP in patients with lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH).

Materials and Methods

A retrospective multicentric analysis of 120 patients with symptomatic BPH was carried out. Patients were enrolled in two centers, in each center all HoLEP procedures were performed by a single experienced operator. Each center enrolled 60 patients, in particular the first 30 consecutive patients undergone HoLEP with Ho:YAG laser 120-W (Lumenis Pulse 120H) and the last 30 patients undergone HoLEP with Ho:YAG laser 100-W (Lumenis VersaPulse 100W Holmium).
All the HoLEP procedures included in the study were performed with the traditional 3 lobes technique as described by Peter Gilling1. All surgical instruments used during the HoLEP were the same for both groups except for the Ho:YAG laser tools. Patient demographics data, peri-operative outcome and 3-months follow-up data were analyzed with the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax), postvoid residual urine volume (PVR), and rates of peri-operative complications

Results

Patients in each group showed no significant difference in pre operative parameters. Compared with the 100-W group, patients in the 120-W group required significantly longer time for laser enucleation (p = 0.038).
Mean peri-operative hemoglobin's decrease in the 120-W HoLEP group was similar to the 100-W group (P > 0.05).
Early incidences of complications not differ significantly between the two groups of 120 W HoLEP and 100-W HoLEP patients (P > 0.05).
At 3 months follow-up, the HoLEP performed with two different Ho:YAG laser compared, did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05).

Discussions

Operative and laser times are longer in the 120W-Group, those differeces can be attributed to technical modifications in the hemostatic phase; the need to apply the laser directly on the vessel to coagulate.
In 100W-Group hemostasis is performed using the same laser setting used during enucleation (2 Joule, 50 Hz), on the other hand in the 120W-Group enucleation is performed using full power setting (2 Joule, 60 Hz) and hemostasis with a different setting (long pulse 2 Joule, 30 Hz) activated using a dedicated second pedal. The reduction of the laser pulse frequency during the hemostasis and the presence of the new double pedal are new aspects when using the 120 W-Ho:YAG laser to perform HoLEP.
Particularly the new method of laser application during hemostasis and use of the second pedal during hemostasis may have negatively affected the first 30 cases performed with the new 120 W-Ho:YAG laser given the need to change established habits of experienced operators with HoLEP performed with 100W Ho:YAG lasers.

Conclusion

120 Watt HoLEP is safe and effective as HoLEP performed with 100 Watts Ho:YAG laser.
In our study laser’s activation time and HoLEP’s operating time are longer in HoLEPs performed with Ho: YAG laser 120 watts are longer than in the group of HoLEP were performed with 100 watt Ho: YAG laser; more studies are needed to determine whether this is due to transition from the Ho: YAG 100 Watts laser (Lumenis Holmium Versapulse 100W) to the new Ho: YAG laser 120 Watts (Lumenis Pulse 120H) or whether it is due to the laser settings used in the process of hemostasis.

References

1- GILLING, P. J., KENNETT, K., DAS, A. K., THOMPSON, D., & FRAUNDORFER, M. R. (1998). Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. Journal of endourology, 12(5), 457-459.
2 – Gupta, N., KUMAR, R., Dogra, P. N., & Seth, A. (2006). Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of> 40 g. BJU international, 97(1), 85-89.
3 – Elzayat, E. A., Habib, E. I., & Elhilali, M. M. (2005). Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology, 66(5), 108-113.
4 – Aho, T., & Gilling, P. (2008). Current techniques for laser prostatectomy-PVP and HoLEP. Archivos Españoles de Urología, 61(9), 1005.
5 – Barry M.J., et al. (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol,148(5): p. 1549-57

Argomenti: