Clinical Scorecard: Evaluating the Use of a 21 Fr Internal Urethrotomy Sheath for HoLEP as a Viable Option to MiLEP in Resource-Constrained Environments
At a Glance
Category
Detail
Condition
Benign Prostatic Hyperplasia (BPH)
Key Mechanisms
Holmium laser enucleation of the prostate (HoLEP) using a modified low-caliber technique to reduce urethral trauma.
Target Population
Patients aged ≥ 50 years with LUTS refractory to medical therapy and prostate volume ≥ 35 mL.
Care Setting
Endourology units in resource-constrained environments.
Key Highlights
HoLEP is effective for large prostates and has a low bleeding risk.
Modified low-caliber HoLEP (mLC-HoLEP) uses a 21 Fr sheath to minimize urethral trauma.
Urethral stricture rates after standard HoLEP range from 2% to 5%.
mLC-HoLEP may provide similar outcomes to standard HoLEP without the need for specialized equipment.
Study included 47 patients undergoing mLC-HoLEP and 48 matched controls undergoing standard HoLEP.
Guideline-Based Recommendations
Diagnosis
Patients with LUTS should be evaluated for BPH, especially if symptoms are refractory to medical therapy.
Management
HoLEP is recommended for surgical treatment of BPH, particularly for larger prostate volumes.
Monitoring & Follow-up
Postoperative follow-up should include assessment of continence status and urethral stricture formation.
Risks
Potential risks include urethral stricture formation and transient urinary incontinence.
Patient & Prescribing Data
Men aged ≥ 50 years with BPH and LUTS.
mLC-HoLEP may be a safe and effective alternative to standard HoLEP in resource-limited settings.
Clinical Best Practices
Utilize available instruments to perform mLC-HoLEP in settings lacking specialized equipment.
Ensure proper patient selection based on inclusion and exclusion criteria.
For years, Maria Diaz, now 64, considered herself unstoppable. A devoted grandmother, and self-described adventurer, she built her retirement around staying active and fit, enjoying travel, and caring for her grandkids.
