‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia

• Published in: World journal of urology Vol. 37; no. 11; pp. 2451 - 2458
• Main Authors: Saitta, Giuseppe, Becerra, José Ernesto Aguayo, del Álamo, Julio Fernández, González, Luis Llanes, Elbers, Javier Reinoso, Suardi, Nazareno, Gómez-Sancha, Fernando
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Benign; Catheterization; Enucleation; Humans; Hyperplasia; Lasers, Solid-State - therapeutic use; Male; Medicine; Medicine & Public Health; Middle Aged; Mucosa; Nephrology; Oncology; Original Article; Postoperative Complications - prevention & control; Prostate; Prostatectomy - methods; Prostatic Hyperplasia - surgery; Sphincter; Time Factors; Urinary incontinence; Urinary Incontinence, Stress - prevention & control; Urine; Urology; Benign prostatic hyperplasia; Holmium laser; Prostate-specific antigen; IPSS; En bloc enucleation
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-019-02671-4

Purpose
HoLEP represents an excellent treatment option for benign prostatic hyperplasia. Recently, ‘en bloc’ techniques resulting in improved visualization, shorter surgical times, and easier recognition of the dissection plane have been described. In this paper we describe the ‘En bloc’ HoLEP technique with early apical release.
Materials and methods
Between January 2015 and March 2017, 137 consecutive patients were subjected to this technique by a single surgeon. The following parameters were measured pre- and post-procedure: International Prostate Symptom Score (IPSS), maximum flow rate (
Q
max
), post-void residual urine (PVR) and PSA. Complications were recorded.
Results
Mean (SD; range) age was 66 years (8.0; 51–84), mean PSA was 4.8 ng/ml (7.0; 0.3–70), mean prostate volume was 75.63 ml (42.1; 37–253), mean volume of prostatic tissue removed was 65.9 ml (35.8; 30–217). Mean surgical duration was 47.58 min (21.3; 15–120 min): enucleation 31.5 min (14.9; 5–80 min), morcellating 6.9 min (6.6; 1–60 min). Mean hospitalization duration was 1.2 days (range 1–3), mean catheterization time was 1.2 days (range 1–5). The rate of stress urinary incontinence (SUI) was 5.8, 1.5 and 0.7% at 1, 3, and 6 months post-operation, respectively. Compared to pre-operative values, IPSS,
Q
max
, and PVR showed significant improvements at 1, 3, 6, and 12 months following the operation (
p
 < 0.05).
Conclusions
‘En Bloc’ HoLEP with early apical release is a safe technique that allows for easier recognition of the surgical plane and preserves the external sphincter’s mucosa to provide low rates of post-operative stress incontinence and significant functional results.