<i>En-Bloc</i> Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm?

Tuccio, Agostino; Grosso, Antonio Andrea; Sessa, Francesco; Salvi, Matteo; Tellini, Riccardo; Cocci, Andrea; Viola, Lorenzo; Verrienti, P.; Camillo, M. Di; Maida, Fabrizio Di; Mari, Andrea; Carini, Marco

doi:10.1089/end.2020.1189

Cited by 32 publications

(7 citation statements)

References 27 publications

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“… 21 - 24 In the present study, the incidence of stress urinary incontinence was considerably higher in the 2-lobe group as compared to the en bloc group, indicating that the en bloc technique is efficient in preserving the external sphincter. In a prospective analysis of 168 patients by Tuccio et al 25 , it was concluded that post-HoLEP, urinary stress was significantly reduced in the en bloc group compared with the traditional 3-lobe technique. Another study by Gong et al 26 observed that post-modified HoLEP in patients with BPH resulted in less postoperative transient stress incontinence in 3 out of 189 patients, with spontaneous recovery within 3 months.…”

Section: Discussionmentioning

confidence: 98%

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique—A Prospective Randomized Study

Mahajan,

Sharma,

Patil

2024

Urology Research & Practice

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Objective: To compare the safety and efficacy of the en bloc technique with the standard 2-lobe technique for holmium laser enucleation of the prostate (HoLEP). Methods: This prospective study included patients with benign prostatic hyperplasia (BPH) who underwent HoLEP from September 2020 to March 2022, by en bloc or 2-lobe technique. Patient demographics, prostate volume, enucleation, morcellation and operative time, and incidence of postoperative incontinence were compared between the 2 groups. Results: We included 64 patients (30 en bloc and 34 2-lobe techniques) who underwent HoLEP in this study. The mean age, prostate volume, creatinine, and PSA of patients were comparable in both groups [(68.53 vs. 67.55 years; P = .62), (79.43 vs. 79.88 g, P = .92), (1.08 mg/dL vs. 1.20 mg/dL, P = .35), (3.78 vs. 4.63 ng/mL; P = .376), respectively]. The enucleation time was significantly shorter in the en bloc group than in the 2-lobe group (54.2 vs. 61.67; P = .03). Additionally, the mean operative time was also comparatively shorter in the en bloc group than the 2-lobe group (72.36 vs. 80.50; P = .057). The improvement in the quality-of-life (QoL) score was significantly better with en bloc than the 2-lobe group (3.80 vs. 2.11; P = .01). There was a significant difference in stress urinary incontinence on days 1, 7, and 30 ( P < .001) with en bloc compared to the two-lobe technique. Conclusion: Although the outcomes of en bloc and 2-lobe endoscopic enucleation of prostate techniques were comparable, the en bloc technique seems to be a better option in most patients undergoing HoLEP due to less enucleation and operative time and lowered stress urinary incontinence incidence.

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Section: Discussionmentioning

confidence: 98%

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique—A Prospective Randomized Study

Mahajan,

Sharma,

Patil

2024

Urology Research & Practice

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“…When compared to the traditional 3-lobe technique, the early apical and en-bloc approach demonstrated a significantly lower occurrence of temporary SUI (13.5% vs 4.5%, P = 0.03) in a series of 168 patients, although the difference was not statistically significant at the 6-month follow-up (4.9% vs 2.3%). 17 This technique encompasses the preservation of the external sphincter mucosa separating it from the striated sphincter by fully demarcating the prostatic apex from the sphincter itself. 18 Yet, the prolonged stretching and traction applied at the apex level during anterior and lateral enucleation could potentially harm the so-called musculus sphincter urethrae glaber, which runs beneath the striated sphincter and close to the mucosa.…”

Section: Discussionmentioning

confidence: 99%

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients

Castellani,

Gauhar,

Fong

et al. 2024

Asian Journal of Andrology

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We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62–73] years vs 69 [63–74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52–92] ml in Group 1 vs 70 [54–90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

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“…In particular, maintaining an anatomical dissection plane, reducing traction to the sphincter during the enucleation and avoiding capsular perforation are together crucial to allow a fast recover from irritative symptoms following HoLEP ( 30 ). Recent evidence also demonstrated the importance of the apical release in the very beginning of the procedure to maximize functional success ( 18 , 31 , 32 ). Moreover, efficacy in relieving BPH-related obstructive symptoms was equally satisfactory both in CCI ≥ 3 and less comorbid patients, as proved by comparable IPSS and Qmax between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Enucleation was performed with the three-lobes or en-bloc with early apical release technique, as described in previous investigations ( 18 , 19 ). All procedures were carried out under general anesthesia using the 120W Versapulse holmium laser machine (Lumenis, Yokneam, Israel) with a 550-µm end laser fiber (Boston Scientific, AccuMax 550 Laser Fiber).…”

Section: Methodsmentioning

confidence: 99%

Holmium laser enucleation of the prostate (HoLEP) is safe and effective in patients with high comorbidity burden

et al. 2023

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Introduction We assessed the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in patients with high comorbidity burden. Materials and methods Data from patients treated with HoLEP at our academic referral center from March 2017 to January 2021 were prospectively collected. Patients were divided according to their CCI (Charlson Comorbidity Index). Perioperative surgical data and 3-month functional outcomes were collected. Results Out of 305 patients included, 107 (35.1%) and 198 (64.9%) were classified as CCI ≥ 3 and < 3, respectively. The groups were comparable in terms of baseline prostate size, symptoms severity, post-void residue and Qmax. The amount of energy delivered during HoLEP (141.3 vs. 118.0 KJ, p=0.01) and lasing time (38 vs 31 minutes, p=0.01) were significantly higher in patients with CCI ≥ 3. However, median enucleation, morcellation and overall surgical time were comparable between the two groups (all p>0.05). Intraoperative complications rate (9.3% vs. 9.5%, p=0.77), median time to catheter removal and hospital stay were comparable between the two cohorts. Similarly, early (30 days) and delayed (>30 days) surgical complications rates were not significantly different between the two groups. At 3-month follow up, functional outcomes using validated questionnaires did not differ between the two groups (all p>0.05). Conclusions HoLEP represents a safe and effective treatment option for BPH also in patients with high comorbidity burden.

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En-Bloc Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm?

Cited by 32 publications

References 27 publications

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique—A Prospective Randomized Study

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique—A Prospective Randomized Study

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients

Holmium laser enucleation of the prostate (HoLEP) is safe and effective in patients with high comorbidity burden

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