[Holmium laser prostate enucleation. All we should aim for.]

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Benign prostatic hyperplasia (BPH) treatment is evolving, with prostate enucleation gaining prominence.
• Holmium laser enucleation of the prostate (HoLEP) is recognized as a safe and efficient energy source for BPH management.
• A significant challenge with HoLEP is its steep learning curve.

Purpose of the Study:

• To provide a detailed, step-by-step description of the HoLEP technique employed at the authors' institution.
• To elucidate the rationale behind the specific procedural steps and modifications.
• To highlight the institution's extensive experience and compare it with existing literature.

Main Methods:

• A comprehensive, sequential explanation of the HoLEP procedure.
• Emphasis on differentiating the described technique from other published methods.
• Leveraging the largest reported experience to validate the technique's efficacy.

Main Results:

• The described HoLEP technique demonstrates excellent short- and long-term functional, safety, and complication outcomes.
• Comparable intraoperative/postoperative blood loss, reoperation rates, and complications like capsular perforations or urethral strictures were observed.
• This technique offers improved surgical efficiency and shorter operative times compared to blocking and trilobular methods.
• Early continence rates were significantly higher (96%) compared to other techniques (60-95%).
• Advancements in morcellator devices have eliminated related surgical complications.

Conclusions:

• HoLEP is confirmed as the gold standard for prostate enucleation in BPH management.
• The technique yields superior functional and safety outcomes compared to alternative procedures.
• Adoption of a standardized and optimized HoLEP technique is crucial for maximizing patient benefits.