‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia
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 (Qmax), post-void residual urine (PVR) and PSA. Complications were recorded.
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, Qmax, and PVR showed significant improvements at 1, 3, 6, and 12 months following the operation (p < 0.05).
‘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.
KeywordsBenign prostatic hyperplasia Prostate-specific antigen IPSS En bloc enucleation Holmium laser
5-Alpha reductase inhibitors
Atypical small acinar proliferation
Benign prostatic hyperplasia
Benign prostatic obstruction
Green light enucleation of prostate
Holmium laser enucleation of prostate
International Prostate Symptom Score
Lower urinary tract symptoms
Post-void residual urine
Maximum peak flow
Quality of life
Stress urinary incontinence
Thulium laser enucleation of prostate
Transurethral resection of prostate
Trial without catheter
Cristina Sala Ripoll - Creative Commons License (CC BY-NC-ND).
SG: protocol/project development, data collection or management, data analysis, manuscript writing/editing. JEAB: protocol/project development, manuscript writing/editing. JFA: protocol/project development. LLG: protocol/project development. JRE: protocol/project development. NS: data collection or management, data analysis, manuscript writing/editing. FG-S: protocol/project development, data collection or management, manuscript writing/editing
Compliance with ethical standards
Conflict of interest
Gómez-Sancha F: Boston Scientific® (proctor, lecturer, advisory board); Lumenis® (lecturer).
All 137 patients signed an informed consent declaring to have understood the purposes, benefits, and risks of the proposed treatment.
- 1.Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S (2018) Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. J Aging Male 2:1–8Google Scholar
- 2.Montorsi F, Saitta G, Suardi N (2018) Surgical treatment for LUTS/BPH: laser devices—chapter 13. In: Morgia G, Russo GI (eds) Lower urinary tract symptoms and benign prostatic hyperplasia, 1st edn. Academic Press, Cambridge. eBook ISBN: 9780128113981. Paperback ISBN: 9780128113974Google Scholar
- 8.Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P (2004) 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 172(5 Pt 1):1926–1929CrossRefGoogle Scholar
- 12.Kelly DC, Das A (2012) Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol. 19(1):6131–6134Google Scholar