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

Abstract

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.