Morphologic Factors Associated With Open Conversion During Holmium Laser Enucleation of the Prostate

To determine if there is an association between patient body habitus as measured by body mass index (BMI), body surface area (BSA), preoperative prostate volume, postoperative specimen weight, and open conversion with cystotomy or perineal urethrotomy (PU) during holmium laser enucleation of the pro...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2020-11, Vol.145, p.258-261
Main Authors: Juvet, Tristan, Parikh, Kevin A., Ball, Colleen T., Dora, Chandler D
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Body Mass Index
Body Surface Area
Conversion to Open Surgery
Cystotomy - adverse effects
Endoscopy - adverse effects
Humans
Lasers, Solid-State - therapeutic use
Male
Middle Aged
Organ Size
Prostatic Hyperplasia - surgery
Retrospective Studies
Risk Factors
Urethra - surgery
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Summary:To determine if there is an association between patient body habitus as measured by body mass index (BMI), body surface area (BSA), preoperative prostate volume, postoperative specimen weight, and open conversion with cystotomy or perineal urethrotomy (PU) during holmium laser enucleation of the prostate (HoLEP). We attempt to provide meaningful criteria to assist in preoperative patient counseling. Three hundred consecutive patients underwent HoLEP between August 3, 2018 and February 20, 2020 by a single surgeon. Patient metrics were recorded in a database including age, height, weight, preoperative prostate volume, postoperative specimen weight, catheter dependence, and transfusion requirement. Nine patients were identified who had cystotomy (8) or PU (1) performed during HoLEP secondary to inability to complete the procedure using standard endoscopic technique. Univariate and multivariate statistical analysis was performed. Younger age, higher BMI, higher BSA, and higher estimated prostate volume were associated with increased risk of open conversion during HoLEP. No patient with a BMI under 30 required open conversion. Men with BMI >30 kg/m2 or preoperative prostate volume >125 mL should be counseled on the possibility of open conversion with cystotomy or PU. Although the overall risk of conversion is low (3%), the risk may be as high as 10% for patients in the highest quartile of BMI (>30.5 kg/m2) and BSA (>2.2m2).
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2020.08.017