HoLEP

Holmium Laser Enucleation of the Prostate

HoLEP provides excellent and durable clinical outcomes with reoperation rate of only 0.7% at 10-Year follow-up. With 43% faster enucleation and 54% hemostasis time and the successful release of >90% patients without catheter on the same day of surgery, HoLEP with MOSES 2.0 is suited for almost all patients, including patients treated with anticoagulants and very large prostates, becoming a truly minimally invasive procedure transforming the way BPH is managed17,18,20

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What is HoLEP

Holmium Laser Enucleation of the Prostate (HoLEP) is a safe and effective BPH treatment option for prostates of all sizes11-15

HoLEP involves enucleation of the median lobe, followed by the lateral lobes. The lobes are placed into the bladder for removal by morcellation. HoLEP is recommended by the AUA for BPH treatment. Among its advantages are a low reoperation rates, and wide patient applicability 11,16.

“I’ve used the MOSES 2.0 technology during stones and BPH procedures for several years because it is so efficient, MOSES 2.0 for HoLEP enucleates tissue even faster and stops bleeding very quickly, which is important for visibility, postoperative recovery and the surgeon’s learning curve. It allowed me to change my entire practice and patients have been very happy to go home the same day without a catheter. This transformation is even more important now that COVID-19 makes patients put off essential care, while our hospitals move to free up inpatient beds for acute cases. MOSES 2.0 helps make that possible.”

Dr. Amy E. Krambeck, Northwestern Medicine

Dr. Amy E. Krambeck

HoLEP with MOSES technology:

  • 43% faster enucleation time 18
  • 67% higher enucleation efficiency 18
  • Same day discharge, catheter-free procedure 17
  • 54% faster hemostasis time 18
  • 80% less fiber burnback18
  • Shorter HoLEP learning curve.

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Clinical Results

HoLEP results are comparable to TURP and Open Prostatectomy

HoLEP vs. TURP1,2,3,4,5,6

  • Lower perioperative morbidity
  • Better bladder outlet obstruction relief
  • Equivalent reoperation rates
  • Minimally invasive
  • Equivalent durability

HoLEP vs. Open Prostatectomy1,2,3,4,5,6

  • Similar AUA symptom scores and Qmax
  • Shorter catheter duration
  • Shorter hospital Stay
  • No blood transfusions required
  • Equivalent durability

HoLEP is durable at 6 years1

QOL,Qmax Ml/s and IPSS outcomes at 6 years are comparable to outcomes at 1 year

HoLEP has fewer complications and lower re-operation rate1,2,3,7,8,9,10

HoLEP and HoLVP are backed by strong clinical evidence

HoLAP/HoLEP are the most studied laser BPH treatments with the highest number of published randomized controlled trials

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References


  1. Holmium Laser Enucleation of the Prostate; Results at 6 Years, Gilling PJ, Aho, TF, Frampton CM, et al. Eur Urol 2008 Apr:53(4):744-9
  2. Holmium Laser Enucleation of the Prostate Versus Open Prostatectomy for Prostates Greater Than 100 Grams; 5-Year Follow-up Results of a Randomized ClinicalTrial, Kuntz RM, Lehrich K, Ahvai S. Eur Urol 2008 Apr:53:160-168
  3. A Randomized Trial Comparing Holmium Laser Enucleation of the Prostate with Transurethral Resection of the Prostate for the Treatment of Bladder Outlet Obstruction, Secondary to Benign Prostatic Hyperplasia in Large Glands (40 to 200 grams), Tan AH, Gilling P, et al. J Urol (Oct. 2003) 170:1270-1274
  4. Randomized Comparison of Transurethral Electroresection and Holmium: YAG Laser Vaporization for Symptomatic Benign Prostatic Hyperplasia, Mottet N, Anidjar J, et al. J Endourol 1999 13:127-130 5 Holmium Laser Enucleation of the Prostate for Prostates of >125mL., Matlaga BR, Lingeman JE, et al. BJU International, 97:81-84, Jan 2006
  5. Holmium Laser Enucleation of the Prostate for Prostates of >125mL., Matlaga BR, Lingeman JE, et al. BJU International, 97:81-84, Jan 2006
  6. Holmium Laser Bladder Neck Incision vs. Holmium Enucleation of the Prostate as Outpatient Procedures for Prostates Less Than 40 Grams: A Randomized Trial, Aho, TF, Gilling P, et al. J Urol, 174, 210-214, Jul 2005
  7. KTP Laser versus transurethral resection: early results of a randomized trial Bouchier-Hayes DM, Anderson P, et al. J Endourol 2006 Vol 20 (8):580-585
  8. Photoselective potassium titanyl phosphate (KTP) laser vaporization vs. transurethral resection of the prostate for prostates larger than 70mL: a short-term prospective randomized trial Horasanli K, Silay M, et al. J Urol 2008 71:247-251
  9. Laser: A Novel Side-Firing Approach for Laser Vaporisation of the Human Prostate – Immediate Efficacy and 1 – Year Follow- Up Seitz M., Sroka, R., et al. Eur Urol 2007 June; 52 1717-1772
  10. Thulium Laser versus Standard Transurethral Resection of the Prostate: A Randomized Trial Xia, S. et al. European Urology 2006 Vol 53 382-390
  11. John Michalak, David Tzou, Joel Funk: HoLEP: the gold standard for the surgical management of BPH in the 21st Century Am J Clin Exp Urol 2015;3(1):36-42
  12. Ehab A. Elzayat, Enmar I. Habib, and Mostafa M. Elhilali: Holmium laser enucleation of the prostate: a size-independent new “gold standard” urology 66 (Supplement 5A), November 2005
  13. Gilling PJ et al, Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 2012; 109(3): 408-11.
  14. Elmansy H et al, Holmium Laser Enucleation Versus Photoselective Vaporization for Prostatic Adenoma Greater than 60 Ml: Preliminary Results of a Prospective, Randomized Clinical Trial. J Urol 2012; 188: 216-221.
  15. Ahyai S et al, Holmium Laser Enucleation versus Transurethral Resection of the Prostate: 3-Year Follow-Up Results of a Randomized Clinical Trial. Eur Urol 2007; 52(5):1456-63.
  16. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH), 2010.
  17. Deepak K. Agarwal a, Tim Large a, Yan Tong b, Christa L. Stoughton a, Erica M. Damler a, Charles U. Nottingham a, Marcelino E. Rivera a, Amy E. Krambeck a. Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus (2021), https://doi.org/10.1016/j.euf.2020.12.018
  18. Nevo A, Faraj KS, Cheney SM, Moore JP, Stern KL, Borofsky M, Gnessin E, Humphreys, at. el Holmium laser enucleation of the prostate using Moses 2.0 vs non-Moses. A randomized controlled trial. BJU Int. 2020
  19. Bristol B Whiles MD, Wilson R Molina MD, Kerri L Thurmon MD. Urology S0090-4295(20)31530-2, doi: 10.1016/j.urology.2020.12.024.
  20. Elmansy HM, Kotb A, Elhilali MM. Holmium laser enucleation of the prostate: long term durability of clinical outcomes and complication rates during 10 years of followup. J Urol. 2011;186(5):1972-6.

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