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

  • Giuseppe Saitta
  • José Ernesto Aguayo Becerra
  • Julio Fernández del Álamo
  • Luis Llanes González
  • Javier Reinoso Elbers
  • Nazareno Suardi
  • Fernando Gómez-SanchaEmail author
Original Article



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.


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).


‘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.


Benign prostatic hyperplasia Prostate-specific antigen IPSS En bloc enucleation Holmium laser 



5-Alpha reductase inhibitors


Atypical small acinar proliferation


Benign prostatic hyperplasia


Benign prostatic obstruction


Green light enucleation of prostate


Holmium laser enucleation of prostate


International Prostate Symptom Score


Lower urinary tract symptoms


Prostate-specific antigen


Post-void residual urine


Maximum peak flow


Quality of life


Standard deviation


Stress urinary incontinence


Thulium laser enucleation of prostate


Transurethral resection of prostate


Trial without catheter



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

Author 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

Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giuseppe Saitta
    • 1
    • 2
  • José Ernesto Aguayo Becerra
    • 1
  • Julio Fernández del Álamo
    • 1
  • Luis Llanes González
    • 1
  • Javier Reinoso Elbers
    • 1
  • Nazareno Suardi
    • 2
  • Fernando Gómez-Sancha
    • 1
    Email author
  1. 1.ICUA-Clínica CEMTROMadridSpain
  2. 2.IRCCS Ospedale San RaffaeleMilanItaly

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