January 2026

UROLOGY

CME: HOLEP AFTER PRIOR AQUABLATION

Amy E. Krambeck, MD, details the step-by-step process of a holmium laser enucleation of the prostate (HoLEP) in a 71-year-old patient with a 160-cc prostate and recurrent symptoms following a failed aquablation. Despite prior intervention and medical therapy, the patient continued experiencing weak stream, incomplete emptying and poor quality of life.

Dr. Krambeck explains why HoLEP is the preferred solution for very large prostates and cases where previous surgical interventions have failed. The video covers:
  • Preoperative considerations and counseling for revision surgery
  • Unique challenges such as scarring, bleeding risk and tissue inflammation
  • Technical adjustments for hemostasis and patient safety
  • Step-by-step surgical technique, including plane development and morcellation
  • Postoperative benefits, such as long-term symptom relief and improved PSA monitoring

​Physicians may claim CME credit after watching this video.
Target Audience
Specialties - ALL
Professions - Administrator, Certified Registered Nurse Anesthetist, Counselor, Genetic Counselor, Non-Physician, Nurse, Occupational Therapist, Physical Therapist, Physician, Physician Assistant, Social Worker, Student, Technician

Objectives
  1. Identify the clinical indications and preoperative considerations for HoLEP in patients with large prostates (=100 cc) and those who have experienced failed prior surgical interventions, including the evaluation of symptoms, urodynamic findings, and patient counseling strategies for revision surgery.
  2. Describe the step-by-step surgical technique of HoLEP, including plane development, technical adjustments for hemostasis, and morcellation, with emphasis on managing unique intraoperative challenges such as scarring, increased bleeding risk, and tissue inflammation encountered in revision cases.
  3. Evaluate the postoperative outcomes and long-term benefits of HoLEP as a definitive treatment for bladder outlet obstruction, including durable symptom relief, improved quality of life, and the role of PSA monitoring in post-enucleation oncologic surveillance.

Accreditation
The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Northwestern University Feinberg School of Medicine designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Credits
AMA PRA Category 1 Credits™ (1.00 hours), ABS CC (1.00 hours), Non-Physician Attendance (1.00 hours)
Amy E. Krambeck, MD, Chief of Endourology and Stone Disease in the Department of Urology, the Edmund Andrews Professor of Urology at Northwestern Medicine

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