Original Article: Clinical Investigation
Laser prostate ablation and enucleation: Analysis of a national
Evgeniy I Kreydin,
and Lori Lerner
Institute of Urology, Keck School of Medicine of University of Southern California,
David Geffen School of Medicine at UCLA,
Los Angeles, California, and
Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA
Abbreviations & Acronyms
BMI = body mass index
BPH = benign prostatic
INR = international
LAP = prostate laser
LEP = laser enucleation
NSQIP = American College
of Surgeons National
TURP = transurethral
resection of the prostate
UTI = urinary tract infection
Correspondence: Evgeniy I
Kreydin M.D., Institute of
Urology, Keck School of
Medicine of University of
Southern California, 1450 Biggy
Street, Los Angeles, CA 90033,
USA. Email: firstname.lastname@example.org
Received 23 October 2017;
accepted 15 February 2018.
Online publication 6 April 2018
Objective: To compare characteristics and outcomes of benign prostatic hyperplasia
patients undergoing prostate laser ablation with those undergoing laser enucleation
using a nationwide cohort.
Methods: Men who underwent prostate laser ablation (n = 10 054) or laser
enucleation (n = 1705) between 2011 and 2015 were identiﬁed by the common
procedural terminology code as recorded in the National Surgical Quality Improvement
Program database. Preoperative, intraoperative and postoperative parameters were
compared between the groups using univariate and multivariate analysis.
Results: Prostate laser ablation patients were older, had more comorbidities and were
more likely to have abnormal laboratory values. Enucleations were signiﬁcantly longer
and more likely to result in a hospital stay >1 day. Enucleation patients were also more
likely to require a blood transfusion postoperatively, but less likely to experience urinary
tract infection and sepsis on both univariate and multivariate analysis adjusted for
preoperative and intraoperative factors.
Conclusions: Although laser enucleation and prostate laser ablation are both
considered minimally invasive techniques, signiﬁcant differences in patient selection,
intraoperative factors and postoperative complications are identiﬁed in this national
cohort. The present study shows that despite similar outcomes in prospective single-
center studies, prostate laser ablation and laser enucleation have distinct practice
patterns in a broader national context.
benign prostatic hyperplasia, laser prostatectomy, national outcomes,
patient characteristics, practice patterns.
Ablation and enucleation are surgical laser techniques utilized for bladder outlet obstruction
as a result of BPH. LEP results in shelling of individual lobes of prostatic adenoma along the
surgical capsule in a fashion similar to simple prostatectomy. LAP is achieved by vaporiza-
tion of the adenoma, working from the surface mucosa toward the surgical capsule. Both
ablation and enucleation are considered minimally invasive techniques with superior safety
proﬁles compared with the reference gold standard of TURP.
Several studies have compared LEP and LAP head-to-head.
While providing invaluable
insight on functional outcomes, these studies are usually limited to a single high-volume sur-
geon or center and might not reﬂect “real-world” experience with laser prostate surgery. In
fact, there is a paucity of literature examining practice patterns of laser prostate surgery across
a wide range of settings and surgeons. In such a broader setting, differences between LAP
and LEP might arise because of distinct learning curves, surgical techniques and equipment
availability – factors that would not be apparent in the hands of an expert surgeon operating
at a single center.
The objective of the present study was to examine how perioperative factors and postopera-
tive outcomes differ for LEP and LAP across a large national cohort that includes a wide
range of practice settings and varying degrees of surgeon experience. We sought to determine
if a diverse national cohort can reﬂect differences between ablation and enucleation, such as a
steeper learning curve, that are not accounted for in single-surgeon or single-center cohorts.
© 2018 The Japanese Urological Association
International Journal of Urology (2018) 25, 549--553 doi: 10.1111/iju.13560