A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe

Area of Science:

• Urology
• Surgical Techniques
• Laser Surgery

Background:

• Holmium Laser Enucleation of the Prostate (HoLEP) is a standard treatment for benign prostate obstruction (BPO).
• Several modifications to the original three-lobe enucleation technique exist.
• Comparative outcome data for different HoLEP enucleation techniques are limited.

Purpose of the Study:

• To compare the outcomes of three distinct HoLEP enucleation techniques: en-bloc, two-lobe, and three-lobe.
• To evaluate operational efficiency and functional results across these HoLEP variations.

Main Methods:

• Prospective data collection from 600 patients undergoing HoLEP for BPO between January and December 2017.
• Randomization of patients into en-bloc, two-lobe, or three-lobe enucleation groups.
• Analysis of operation time, perioperative parameters, and functional outcomes using ANOVA and Chi2 tests.

Main Results:

• No significant differences in patient characteristics were observed between the groups (p > 0.05).
• Significant differences were found in overall operation time (p < 0.001), speed (g/min) (p = 0.006), and enucleation time (p < 0.001).
• En-bloc and two-lobe techniques were significantly faster than the three-lobe technique, with no significant differences between en-bloc and two-lobe methods.

Conclusions:

• All three HoLEP enucleation techniques yield comparable postoperative outcomes for BPO.
• En-bloc and two-lobe HoLEP demonstrate superior efficiency in terms of operation time and speed compared to the three-lobe technique.