‘Top-Down’ holmium laser enucleation of the prostate. Report of initial cases performed by a single surgeon

Figures & data

Figure 1. Important steps of Top-Down HoLEP

Table 1. Patients’ characteristics and preoperative data

Characteristic		Value
Age, years, median (range)		72.8 (54–88)
Presentation, n (%)	LUTS	24 (40)
	Retention	20 (33.4)
	Retention + bladder stones	6 (10)
	Haematuria	4 (6.7)
	Clot retention	3 (5)
	Retention + ARF	2 (3.3)
	LUTS + haematuria	1 (1.6)
Prostate size, mL, median (range)		124 (70–266)
Prostate size >100 mL, n (%)		37 (61.7)
Preoperative PSA level, ng/ml, median (range)		6 (0.84–27.1)
Preoperative IPSS, median (range)		21 (10–34)
Preoperative QoL, median (range)		5 (2–6)
Preoperative PVR, mL, median (range)		400 (11–2600)
Preoperative Qmax, mL/s, median (range)		8.4 (5.5–15)
Recurrent after TURP, n (%)		16 (26.7)

Table 2. Top-Down postoperative outcome measures at 1, 3, 6, and 12 months

Variable	Value	P
Number of patients 1 month 3 months 6 months 12 months	60 60 59 57
IPSS, median (range) 1 month 3 months 6 months 12 months	5 (0–19) 4 (0–21) 2 (0–14) 2 (0–9)	0.045
QoL, median (range) 1 month 3 months 6 months 12 months	1 (0–5) 1 (0–5) 0 (0–4) 0 (0–4)	0.04
PVR, median (range) 1 month 3 months 6 months 12 months	36.5 (0–194) 55 (0–190) 26 (0–142) 29 (0–153)	0.12
Qmax, mL/s, median (range) 1 month 3 months 6 months 12 months	23.6 (13–48.7) 25.4 (12.3–48.7) 29.4 (10.8–48) 28.5 (9.6–58.6)	0.17
PSA level, ng/mL, median (range) Preoperative 3-months	6 (0.84–27.1) 0.59 (0.16–9)	<0.001

Table 3. Comparison among learning curve groups in relation to the operative and postoperative outcomes

Variable	First 20 cases	Second 20 cases	Last 20 cases	P
Enucleation time, min, median (range)	91 (50–130)	86 (25–184)	67 (45–200)	0.56
Resected weight, g, median (range)	95 (27–190)	81 (44–236)	86 (34–242)	0.76
Enucleation efficiency, g/min, median (range)	0.86 (0.4–1.34)	0.9 (0.42–1.9)	0.91 (0.63–3.7)	0.99
SUI, n (%)	1 (5)	2 (10)	0	0.35
12-month % IPSS improvement, median (range)	81.25 (72.7–93.3)	82.54 (42.2–100)	82.35 (60–100)	0.98
12-month % QoL improvement, median (range)	80 (50–100)	81.7 (33.3–100)	85.5 (66.7–100)	0.58
12-month % PVR improvement, median (range)	93.3 (36.1–100)	90.86 (58.3–100)	100 (43.8–100)	0.28
12-month % Qmax improvement, median (range)	170.3 (100–198.2)	200.4 (103–436.5)	235.3 (110–648)	0.2