Prostate hypertrophy 'Holep Surgery' proves effective and safe treatment
Sep 05, 2024
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A team led by Professor Oh Seung-joon of the Department of Urology at Seoul National University Hospital announced the results of analyzing changes in clinical indicators and quality of life before and after surgery on 3,000 Korean patients from 2008 to 2022. The study was the largest in the world as a single institution.
Prostate hypertrophy is a common disease in middle-aged men, and appears in half of men in their 50s and 60% of men in their 60s. The frequency of occurrence increases with age, and when the prostate is enlarged, it can cause urination disorders by compressing the urethra. If medication is not effective, surgical treatment is required.
Holep surgery is a method of completely removing enlarged prostate tissue with a holmium laser, which has less bleeding, faster recovery, and can be applied regardless of the size of the prostate. In particular, the possibility of recurrence is low by applying the principle of 'separation extraction' that completely removes the enlarged tissue, so long-term effects can be expected. Although various surgical methods have recently emerged, surgery that does not completely remove the prostate hypertrophic tissue may have the potential to recur in the long run.
This study evaluated the effectiveness and safety before and after surgery through systematic follow-up after performing holop surgery on 3000 patients with prostatic hypertrophy at Seoul National University Hospital from August 2008 to June 2022. In particular, this study adopted a prospective research method to follow up patients at 2, 3, and 6 months postoperative according to the same treatment flow protocol, and increased reliability by objectively collecting data using standardized questionnaires.
As a result of the study, the International Prostate Symptom Score (IPSS), an indicator of the severity of symptoms due to prostate hypertrophy, improved significantly from an average of 19.3 points before surgery to 6.6 points at 6 months after surgery, and the maximum urine velocity (Qmax), which means the rate at which urine comes out during urination, increased from 9.4 mL/s to 22.2 mL/s, significantly improving urination ability. In addition, the post-void residual volume also decreased significantly at 6 months after surgery, and the irritable bladder symptom score (QABSS) also improved significantly.
The study is the only globally focused assessment of a patient's subjective experience, with 92.0% of the patients saying they were satisfied with the treatment and 98.2% saying their symptoms improved overall. In addition, 94.5% of patients responded that they are willing to undergo surgery again, demonstrating that holep surgery is a very effective and highly satisfactory surgical method in the treatment of prostatic hypertrophy.
Major postoperative complications included temporary incontinence and bladder neck stenosis, but the incidence was lower than in previous studies. In particular, the incidence of abdominal pressure urinary incontinence was 1.9% after 6 months, which is significantly lower than the figure (3.4-3.5%) reported in large studies in the United States and Canada. Most of the urinary incontinence disappeared naturally over time, and most were mild and no additional surgery was required for urinary incontinence. In addition, there were no cases of reoperation due to recurrence of prostate hypertrophy. The research team explained that these results are an important basis for proving the excellent safety of holop surgery conducted by domestic medical staff.
Professor Oh Seung-joon of the Department of Urology said, "This study clearly shows that hollep surgery is the most effective and safe method for the treatment of prostatic hyperplasia. Based on data accumulated over 15 years, this study is expected to provide a new standard for the treatment of prostatic hyperplasia as well as an important reference for the urology community at home and abroad."
The results of this study were published in the recent issue of the international journal 『Investigative and Clinical Urology" published by the Korean Society of Urinary Medicine.
Meanwhile, Professor Oh Seung-joon has been working steadily to spread the method since he introduced holop surgery in Korea in 2008. Starting with the HOLEP Surgery Symposium in 2009, he taught medical staff across the country about HOLEP surgery and took the lead in training doctors. He is the largest author who has published 28 papers on holop surgery, writing 8.7% of global holop papers and 51% of domestic papers, and has passed on technology at home and abroad by developing EVAMI techniques, a new surgical technique for preserving sphincter function.
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