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

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Abstract

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 (Qmax), 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, Qmax, 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.

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Abbreviations

5-ARI:

5-Alpha reductase inhibitors

ASAP:

Atypical small acinar proliferation

BPH:

Benign prostatic hyperplasia

BPO:

Benign prostatic obstruction

GreenLEP:

Green light enucleation of prostate

HoLEP:

Holmium laser enucleation of prostate

IPSS:

International Prostate Symptom Score

LUTS:

Lower urinary tract symptoms

PSA:

Prostate-specific antigen

PVR:

Post-void residual urine

Q max :

Maximum peak flow

QoL:

Quality of life

SD:

Standard deviation

SUI:

Stress urinary incontinence

ThuLEP:

Thulium laser enucleation of prostate

TURP:

Transurethral resection of prostate

TWOC:

Trial without catheter

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Acknowledgements

Cristina Sala Ripoll - Creative Commons License (CC BY-NC-ND).

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Authors and Affiliations

  1. ICUA-Clínica CEMTRO, Av. Ventisquero de la Condesa 42, 28035, Madrid, Spain

    Giuseppe Saitta, José Ernesto Aguayo Becerra, Julio Fernández del Álamo, Luis Llanes González, Javier Reinoso Elbers & Fernando Gómez-Sancha

  2. IRCCS Ospedale San Raffaele, Via Stamira d’Ancona 20, 20127, Milan, Italy

    Giuseppe Saitta & Nazareno Suardi

Authors
  1. Giuseppe Saitta
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  2. José Ernesto Aguayo Becerra
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  3. Julio Fernández del Álamo
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  4. Luis Llanes González
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  5. Javier Reinoso Elbers
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  6. Nazareno Suardi
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  7. Fernando Gómez-Sancha
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Contributions

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

Corresponding author

Correspondence to Fernando Gómez-Sancha.

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Conflict of interest

Gómez-Sancha F: Boston Scientific® (proctor, lecturer, advisory board); Lumenis® (lecturer).

Informed consent

All 137 patients signed an informed consent declaring to have understood the purposes, benefits, and risks of the proposed treatment.

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Saitta, G., Becerra, J.E.A., del Álamo, J.F. et al. ‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia. World J Urol 37, 2451–2458 (2019). https://doi.org/10.1007/s00345-019-02671-4

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  • DOI: https://doi.org/10.1007/s00345-019-02671-4

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