To demonstrate the performance of a novel holmium laser enucleation technique in patients with lower urinary tract symptoms (LUTS).
Materials and methods
Between September 2015 and August 2017, 114 consecutive patients underwent modified HoLEP [3 horse shoe-like incision HoLEP (3 HSI HoLEP)] for LUTS performed by an experienced urologist (A.M.). The surgical intervention and short postoperative course were analyzed. International Prostate Symptom Score (IPSS), quality of life score, maximum urinary flow rate (Q max), postvoid residual urine (PVR), and clinical and sociodemographic data were assessed preoperatively. The patient cohort was compared with existing data regarding clinical outcome parameters after surgical LUTS therapy.
The mean size of the prostatic gland was 86.3 ± 46.5 mL. The mean total operative time was 49.6 min (15–280 min). IPSS, Q max, and PVR were 20.7, 10.8, and 112.7 mL, respectively, prior to the intervention in the 3 HSI HoLEP group. The complication rate for Clavien category-III complications was 4.4%; no category IV complications were recorded. Seven of 114 patients experienced urinary retention after catheter removal during the hospital stay.
The presented procedure provides several improvements over the standard modality. The prostatic gland is enucleated en bloc in an anatomical manner without longitudinal incisions of the urethra. This method is fast, safe, and may be easier to learn. However, this is the first description recorded. Future multicenter, controlled studies should clarify the long-term outcomes and surgical performance of 3 HSI HoLEP.
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Conflict of interest
None of the other authors has any conflict of interest or financial ties relevant to this work to disclose. No external funding was received for this study.
The study was approved by our local ethics committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments (number 178/17, Ethics Committee of the University Medical Center Freiburg). For this type of study formal consent was not required. This article does not contain any studies with animals performed by any of the authors.
German Clinical Trial Register ID
DRKS00013024 (approved WHO primary register).
Electronic supplementary material
Below is the link to the electronic supplementary material.
Plot of surgery time in relation to prostate size for conventional holmium laser enucleation of the prostate (HoLEP) and 3 horse shoe-like incision HoLEP Pearson’s correlation coefficient (R) is shown for both procedures. Median is given in green (PNG 23 kb)
Plot of surgery time per mL of prostate volume for the different procedures. Blue depicts regular holmium laser enucleation of the prostate (HoLEP), while red dots depict 3 horse shoe-like incision (HSI) HoLEP procedures. The mean is shown in light green. 3 HSI HoLEP was associated with a significant lower surgery time per mL (p = 0.0001). (PNG 36 kb)
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Cite this article
Miernik, A., Schoeb, D.S. “Three horse shoe-like incision” holmium laser enucleation of the prostate: first experience with a novel en bloc technique for anatomic transurethral prostatectomy. World J Urol 37, 523–528 (2019). https://doi.org/10.1007/s00345-018-2418-0
- Benign prostatic obstruction, BPO
- Laser therapy/methods
- Lower urinary tract symptoms, LUTS
- Prostatic hyperplasia/surgery
- Minimally invasive surgical procedures/methods