Contemporary results of En Bloc holep for large prostates

The aim of this study was to compare patients undergoing En Bloc HoLEP with early apical release and sphincter preservation, accordingly to prostate size regarding perioperative data and postoperative evolution.

754 patients were studied and divided into 2 groups: prostate ≤ 120 g (644 patients) and prostate ≥ 120 g, (110 patients). Surgeries were performed by a single surgeon (Fernando Gómez Sancha) using a 150 W high power Holmium laser (Quanta SpA, Samarate, Italy), The technique was En-Bloc with early apical release and sphincter preservation. Prostate volume, PSA, Q max, IPSS among other parameters were assessed before surgery and 3, 6 and 12 months after the procedure. Urinary incontinence (UI) was defined as any leakage reported by patients; classified by duration (< 1 month, 1-3 months, and > 3 months) and type (urge, stress, or mixed).

The mean age was 67.2 years 67.2 years (± 8,4). Enucleation time was longer in the larger prostate group (40.0 vs. 25.0 min, p < 0.0001), as well as morcellation time (13.0 vs. 5.0 min, p < 0.0001). Enucleation (3.1 vs. 1.9 g/min, p < 0.0001) and morcellation efficiency (7.7 vs. 1.5 g/min, p = 0.0015) were higher in the large prostate group. At 6 months the incidence of STUI was extremely low without difference between groups (0.9% vs. 0.15%, p = 0.27).

In conclusion, the study shows that the En-Bloc technique with early release and sphincter preservation has excellent continence results and low complication rates even for prostates larger than 120 g. Technical refinement and care with apical enucleation should be one of the fundamental axes of the training and development of surgeons in performing HoLEP, especially in large prostates.