Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation:: Preliminary results

Objectives: To determine the feasibility of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation to surgically treat bladder outflow obstruction due to the larger prostate. Methods: The first 14 patients treated with this new combination technique are described. Standard preoperative investigations were performed and all patients were assessed at 1 month postoperatively with an AUA symptom score and peak urinary flow rate (Q(max),,,). Both transurethral (8 patients) and suprapubic (6 patients) morcellation was utilised. Results: The mean ultrasound volume of the prostate was 98.6 mi (55-200). The mean total operating room time was 98 min (64-190). No patient required blood transfusion but 2 patients required postoperative bladder irrigation. Twelve of the patients were discharged catheter-free the following day. The only significant complication was extraperitoneal extravasation from the suprapubic site in 2 patients. At 1 month the mean Q(max),, was 25.2 ml/s and the mean AUA score was 7.2. Conclusions: This combination of techniques offers a minimally morbid method of treating the larger prostate gland.