Objective: This study was aimed at reporting the initial experience with prostatic arterial embolization (PAE) followed by holmium laser enucleation of the prostate (HoLEP) as a planned combined approach for extremely enlarged benign prostate hyperplasia (BPH), and retrospectively estimating the efficacy and safety of this novel technique. Patients and Methods: Twenty-four BPH patients who underwent PAE and subsequent HoLEP were included. The PAE procedure was performed under local anesthesia at the supine position with polyvinyl alcohol spherical particles and gelatin sponge particles. HoLEP was performed 3 months after PAE by the “en-bloc” enucleation technique. Clinical data before and 6 months after the procedure were analyzed. Results: PAE and HoLEP were technically successful in all 24 patients. The mean prostate volume was 219 ± 38 mL; the mean total operative time and enucleation time for HoLEP were 117.8 ± 21.9 and 83.5 ± 15.4 min, respectively; and the mean resected prostate weight was 118.3 ± 20.7 g. No transurethral resection of the prostate syndrome was observed during and after HoLEP. The estimated blood loss during HoLEP was 72.1 ± 33.7 mL, and no case required transfusion. International Prostate Symptom Score and post void residual volume decreased significantly (24.1 ± 2.84 vs. 13.5 ± 3.39, p < 0.001; 107.1 ± 40.8 vs. 21.8 ± 16.8, p < 0.001, respectively), maximal flow rate increased significantly (6.25 ± 1.42 vs. 17.63 ± 16.56, p < 0.001), and prostatic specific antigen level also decreased after the procedure (9.29 ± 2.28 vs. 4.99 ± 1.35, p < 0.001). Conclusions: PAE followed by HoLEP as a planned combined approach can be performed safely, feasibly, and efficiently in patients with extremely enlarged BPH.

Keywords:
Holmium laser, Benign prostate hyperplasia, Extremely enlarged gland, Prostatic arterial embolization
1.
Oelke M, Bachmann A, Descazeaud A, et al: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013;64:118-140.
2.
Reich O, Gratzke C, Stief CG: Techniques and long-term results of surgical procedures for BPH. Eur Urol 2006;49:970-978.
3.
Saredi G, Pacchetti A, Pirola GM, et al: Impact of thulium laser enucleation of the prostate on erectile, ejaculatory and urinary functions. Urol Int 2016;97:397-401.
4.
Fraundorfer MR, Gilling PJ: Holmium: YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998;33:69-72.
5.
Gilling PJ, Williams AK: Holmium laser enucleation of the prostate is the single best treatment for benign prostatic hyperplasia refractory to medication. J Endourol 2008;22:2113-2115.
6.
Michalak J, Tzou D, Funk J: HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol 2015;3:36-42.
7.
Kuntz RM, Lehrich K, Ahyai SA: Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 2008;53:160-166.
8.
Tan AH, Gilling PJ, Kennett KM, et al: 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). J Urol 2003;170(4 pt 1):1270-1274.
9.
Lebdai S, Delongchamps NB, Sapoval M, et al: Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia. World J Urol 2016;34:625-632.
10.
McWilliams JP, Kuo MD, Rose SC, et al: Society of interventional radiology position statement: prostate artery embolization for treatment of benign disease of the prostate. J Vasc Interv Radiol 2014;25:1349-1351.
11.
Sivarajan G, Borofsky MS, Shah O, et al: The role of minimally invasive surgical techniques in the management of large-gland benign prostatic hypertrophy. Rev Urol 2015;17:140-149.
12.
Cornu JN, Ahyai S, Bachmann A, et al: A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015;67:1066-1096.
13.
Yin L, Teng J, Huang CJ, et al: Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 2013;27:604-611.
14.
Ahyai SA, Gilling P, Kaplan SA, et al: Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 2010;58:384-397.
15.
van Rij S, Gilling PJ: In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new ‘gold standard'. Curr Urol Rep 2012;13:427-432.
16.
Elshal AM, Mekkawy R, Laymon M, et al: Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country? World J Urol 2016;34:399-405.
17.
DeMeritt JS, Elmasri FF, Esposito MP, et al: Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 2000;11:767-770.
18.
Carnevale FC, Antunes AA, da Motta Leal Filho JM, et al: Prostatic artery Embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2010;33:355-361.
19.
Pisco JM, Pinheiro LC, Bilihm T, et al: Prostatic arterial embolisation to treat benign prostatic hyperplasia. J Vasc Interv Radiol 2011;22:11-19.
20.
Gabr AH, Gabr MF, Elmohamady BN, et al: Prostatic artery embolization: a promising technique in the treatment of high-risk patients with benign prostatic hyperplasia. Urol Int 2016;97:320-324.
21.
Rastinehad AR, Caplin DM, Ost MC, et al: Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 2008;71:181-184.
22.
Nabi G, Sheikh N, Greene D, et al: Therapeutic transcatheter arterial embolization in the management of intractable haemorrhage from pelvic urological malignancies: preliminary experience and long-term follow-up. BJU Int. 2003;92:245-247.
23.
Kelly DC, Das A: Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol 2012;19:6131-6134.
24.
Dusing MW, Krambeck AE, Terry C, et al: Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique. J Urol 2010;184:635-640.
25.
Scoffone CM, Cracco CM: The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol 2016;34:1175-1181.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.