Korean J Urol.  2013 Mar;54(3):189-193.

Postoperative Infectious Complications in Our Early Experience With Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

• Shigemura
• Tanaka K
• Haraguchi
• Yamamichi
• Muramaki M
• Miyake H
• Fujisawa M

Abstract

PURPOSE
The objective of this study was to retrospectively investigate postoperative infectious complications (PICs) in our early experience with holmium laser enucleation of the prostate (HoLEP) followed by mechanical morcellation for symptomatic benign prostatic hyperplasia.
MATERIALS AND METHODS
A retrospective review was performed of the clinical data for 90 consecutive patients who underwent HoLEP at our institution between February 2008 and March 2011. All patients were evaluated for the emergence of PICs, including prophylactic antibiotic administration (PAA) and the influence of the kind or duration of PAA on PIC. The details of cases with PICs were also examined.
RESULTS
The patients' mean age was 71 years (range, 50 to 95 years), and their mean prostate volume was 60 mL (range, 2 to 250 mL). There were 7 cases (7.78%) with PICs; in detail, 3 patients were diagnosed with prostatitis, 2 with pyelonephritis, and 2 with epididymitis. Three patients had positive urine cultures: 1 had Serratia marcescens/Proteus mirabilis, 1 had S. marcescens, and 1 had Klebsiella pneumonia; only one case had urological sepsis. Our statistical data showed no significant differences between 2 or fewer days and 3 or more days of PAA and PIC occurrence. There was also no significant effect on PIC occurrence of sulbactam/ampicillin compared with other antibiotics.
CONCLUSIONS
The results of this retrospective study showed that PIC occurrence did not depend on the duration or the kind of PAA. Further prospective study is necessary for the evaluation and establishment of prophylactic measures for PICs.

Keyword

Benign prostatic hyperplasia; Holmium; Infection; Lasers; Postoperative complication; Prostatectomy

MeSH Terms

Epididymitis
Holmium
Humans
Klebsiella
Lasers, Solid-State
Male
Mirabilis
Postoperative Complications
Prospective Studies
Prostate
Prostatectomy
Prostatitis
Pyelonephritis
Retrospective Studies
Sepsis
Serratia
Holmium

Reference

1. Lee SH, Chung BH, Kim CS, Lee HM, Kim CI, Yoo TK, et al. Survey on benign prostatic hyperplasia distribution and treatment patterns for men with lower urinary tract symptoms visiting urologists at general hospitals in Korea: a prospective, non-controlled, observational cohort study. Urology. 2012. 79:1379–1384.

2. Hong KP, Byun YJ, Yoon H, Park YY, Chung WS. Prospective factor analysis of alpha blocker monotherapy failure in benign prostatic hyperplasia. Korean J Urol. 2010. 51:488–491.

3. Furuya R, Ogura H, Furuya S, Masumori N. Study of patients with symptomatic benign prostatic hyperplasia who underwent transurethral resection of the prostate after ineffective alpha-1 blocker treatment by non-urologists. Hinyokika Kiyo. 2006. 52:95–98.

4. Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, et al. Outline of JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol. 2011. 18:741–756.

5. Lee NG, Xue H, Lerner LB. Trends and attitudes in surgical management of benign prostatic hyperplasia. Can J Urol. 2012. 19:6170–6175.

6. Berardinelli F, Hinh P, Wang R. Minimally invasive surgery in the management of benign prostatic hyperplasia. Minerva Urol Nefrol. 2009. 61:269–289.

7. Eltabey MA, Sherif H, Hussein AA. Holmium laser enucleation versus transurethral resection of the prostate. Can J Urol. 2010. 17:5447–5452.

8. Kelly DC, Das A. Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol. 2012. 19:6131–6134.

9. Hwang JC, Park SM, Lee JB. Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve. Korean J Urol. 2010. 51:619–624.

10. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999. 27:97–132.

11. Bae J, Choo M, Park JH, Oh JK, Paick JS, Oh SJ. Holmium laser enucleation of prostate for benign prostatic hyperplasia: seoul national university hospital experience. Int Neurourol J. 2011. 15:29–34.

12. Zhao CB, Li JC, Yuan PQ, Hong YQ, Lu B, Zhao SC. A meta-analysis of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Zhonghua Nan Ke Xue. 2011. 17:1112–1120.

13. Suardi N, Gallina A, Salonia A, Briganti A, Cestari A, Guazzoni G, et al. Open prostatectomy and the evolution of HoLEP in the management of benign prostatic hyperplasia. Minerva Urol Nefrol. 2009. 61:301–308.

14. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2008. 179:5 Suppl. S87–S90.

15. Shah HN, Mahajan AP, Hegde SS, Bansal MB. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int. 2007. 100:94–101.

16. Knopf HJ, Funke PJ. Significance of bacterial prostatic colonization for nosocomial urinary tract infections after transurethral prostate resection. Urologe A. 2000. 39:432–435.

17. Kuo RL, Paterson RF, Siqueira TM Jr, Watkins SL, Simmons GR, Steele RE, et al. Holmium laser enucleation of the prostate: morbidity in a series of 206 patients. Urology. 2003. 62:59–63.

18. Djavan B, Eckersberger E, Handl MJ, Brandner R, Sadri H, Lepor H. Durability and retreatment rates of minimal invasive treatments of benign prostatic hyperplasia: a cross-analysis of the literature. Can J Urol. 2010. 17:5249–5254.

19. Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K, et al. Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol. 2007. 14:890–909.

20. Raz R, Almog D, Elhanan G, Shental J. The use of ceftriaxone in the prevention of urinary tract infection in patients undergoing transurethral resection of the prostate (TUR-P). Infection. 1994. 22:347–349.

21. Grabe M, Forsgren A, Hellsten S. Species distribution and antibiotic sensitivity of bacteria isolated pre- and postoperatively from patients undergoing transurethral prostatic resection. Scand J Urol Nephrol. 1984. 18:187–192.

22. Guyot A, Barrett SP, Threlfall EJ, Hampton MD, Cheasty T. Molecular epidemiology of multi-resistant Escherichia coli. J Hosp Infect. 1999. 43:39–48.