Nicole L. Miller, MD, FACS, presented “When All Else Fails: Holmium Laser Enucleation of the Prostate as Retreatment for BPH” during the 40th Annual Ralph E. Hopkins Urology Seminar on February 5th, 2020 in Jackson Hole, Wyoming.
How to cite: Miller, Nicole L. “When All Else Fails: Holmium Laser Enucleation of the Prostate as Retreatment for BPH” February 5th, 2020. Accessed Nov 2024. https://grandroundsinurology.com/when-all-else-fails-holmium-laser-enucleation-of-the-prostate-as-retreatment-for-bph/
Summary:
Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses Holmium laser enucleation of the prostate (HoLEP), particularly focusing on the retreatment setting. AUA guidelines have recently been updated and now mirror EAU guidelines which suggest sizing a prostate before determining treatment options. Dr. Miller examines case studies that underscore the effectiveness of HoLEP in removing large prostates after the patients had previously undergone unsuccessful treatments, including transurethral resection of the prostate (TURP) and prostatic urethral lift. She then analyzes outcomes of a study that compared primary HoLEP (pHoLEP) to retreatment (rHoLEP) observing that the retreatment setting patients experienced shorter operative times, shorter length of stay, had less tissue resected, and had a higher rate of urethral stricture and clot retention. In spite of its utility, HoLEP has not been widely adopted and represents 4% of procedures, which Dr. Miller attributes to the steep learning curve associated with HoLEP. Lastly, she enumerates the barriers within the US medical system to physicians undertaking the HoLEP learning process and concludes that while Europe has numerous options for physicians to learn the technique, the American focus on robotic surgery means that fewer students learn open orifices surgical procedures.
About The 40th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Miller presented this lecture during the 40th iteration of the meeting on February 5th, 2020 in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Nicole L. Miller, MD, FACS, is an Associate Professor of Urology at Vanderbilt University Medical Center, where she is also on faculty for Vanderbilt’s Fellowship in Endourology and Laparoscopic Surgery. A graduate of the University of Pittsburgh School of Medicine, she received her urology residency training at the University of Virginia Health Sciences Center before completing a two-year fellowship in Endourology and Minimally Invasive Surgery at Indiana University School of Medicine. Dr. Miller’s specialties include medical and surgical treatment of kidney stone disease and BPH. Her research interests include the changing composition of renal calculi, the pathophysiology and etiologies of nephrolithiasis, and antibiotic selection for kidney stone treatment. Dr. Miller’s work has been published in the Journal of Urology, Urolithiasis, and the Journal of Endourology, among others.
