Advertisement

‘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

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.

Keywords

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

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

Qmax

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

Notes

Acknowledgements

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.

References

  1. 1.
    Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S (2018) Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. J Aging Male 2:1–8Google Scholar
  2. 2.
    Montorsi F, Saitta G, Suardi N (2018) Surgical treatment for LUTS/BPH: laser devices—chapter 13. In: Morgia G, Russo GI (eds) Lower urinary tract symptoms and benign prostatic hyperplasia, 1st edn. Academic Press, Cambridge. eBook ISBN: 9780128113981. Paperback ISBN: 9780128113974Google Scholar
  3. 3.
    Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043CrossRefGoogle Scholar
  4. 4.
    Gilling PJ, Fraundorfer MR (1998) Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol 8(1):11–15CrossRefGoogle Scholar
  5. 5.
    Yin L, Teng J, Huang CJ, Zhang X, Xu D (2013) Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 27(5):604–611CrossRefGoogle Scholar
  6. 6.
    Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411CrossRefGoogle Scholar
  7. 7.
    Moody JA, Lingeman JE (2001) Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy. J Urol 165(2):459–462CrossRefGoogle Scholar
  8. 8.
    Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P (2004) Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 172(5 Pt 1):1926–1929CrossRefGoogle Scholar
  9. 9.
    Glybochko PV, Rapoport LM, Enikeev ME, Enikeev DV (2017) Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks. Urologia 84(3):169–173.  https://doi.org/10.5301/uj.5000232 (Epub 2017 May 10) CrossRefGoogle Scholar
  10. 10.
    Hurle R, Vavassori I, Piccinelli A, Manzetti A, Valenti S, Vismara A (2002) Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia. Urology 60(3):449–453CrossRefGoogle Scholar
  11. 11.
    Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR (1995) Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol 9(2):151–153CrossRefGoogle Scholar
  12. 12.
    Kelly DC, Das A (2012) Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol. 19(1):6131–6134Google Scholar
  13. 13.
    Krambeck AE, Handa SE, Lingeman JE (2010) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 183(3):1105–1109CrossRefGoogle Scholar
  14. 14.
    Baazeem AS, Elmansy HM, Elhilali MM (2010) Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 105(5):584–585CrossRefGoogle Scholar
  15. 15.
    Scoffone CM, Cracco CM (2016) The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol 34(8):1175–1181CrossRefGoogle Scholar
  16. 16.
    Minagawa S, Okada S, Morikawa H (2017) Safety and effectiveness of holmium laser enucleation of the prostate using a low-power laser. Urology. 110:51–55.  https://doi.org/10.1016/j.urology.2017.08.034 (Epub 2017 Sep 4) CrossRefGoogle Scholar
  17. 17.
    Hiraoka Y, Shimizu Y, Iwamoto K, Takahashi H, Abe H (2007) Trial of complete detachment of the whole prostate lobes in benign prostate hyperplasia by transurethral enucleation of the prostate. Urol Int 79(1):50–54CrossRefGoogle Scholar
  18. 18.
    Hiraoka Y (1983) A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia. J Nippon Med Sch 50:896–898CrossRefGoogle Scholar
  19. 19.
    Hiraoka Y, Akimoto M (1989) Transurethral enucleation of benign prostatic hyperplasia. J Urol 142:1247–1250CrossRefGoogle Scholar
  20. 20.
    Shimizu Y, Hiraoka Y, Iwamoto K, Takahashi H, Abe H (2005) Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique. Urol Int 74:102–107CrossRefGoogle Scholar
  21. 21.
    Kim YJ, Lee YH, Kwon JB, Cho SR, Kim JS (2015) A novel one lobe technique of thulium laser enucleation of the prostate: ‘all-in-one’ technique. Korean J Urol 56(11):769–774CrossRefGoogle Scholar
  22. 22.
    Gomez Sancha F, Cuadros Rivera V, Georgiev G, Bocevski A, Kotsev J, Herrmann T (2015) Common trend: move to enucleation—is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33(4):539–547CrossRefGoogle Scholar
  23. 23.
    Gong YG, He DL, Wang MZ, Li XD, Zhu GD, Zheng ZH, Du YF, Chang LS, Nan XY (2012) Holmium laser enucleation of the prostate: a modified enucleation technique and initial results. J Urol 187(4):1336–1340CrossRefGoogle Scholar
  24. 24.
    Kuo RL, Paterson RF, Kim SC, Siqueira TM Jr, Elhilali MM, Lingeman JE (2003) Holmium laser enucleation of the prostate (HoLEP): a technical update. World J Surg Oncol 1(1):6CrossRefGoogle Scholar
  25. 25.
    Minagawa S, Okada S, Sakamoto H, Toyofuku K, Morikawa H (2015) En-Bloc technique with anteroposterior dissection holmium laser enucleation of the prostate allows a short operative time and acceptable outcomes. Urology 86(3):628–633CrossRefGoogle Scholar
  26. 26.
    Miernik A, Schoeb DS (2018) “Three horse shoe-like incision” holmium laser enucleation of the prostate: first experience with a novel en bloc technique for anatomic transurethral prostatectomy. World J Urol.  https://doi.org/10.1007/s00345-018-2418-0 Google Scholar
  27. 27.
    Rapoport LM, Sorokin NI, Sukhanov RB, Dymov AM, Enikeev DV, Davydov DS, Danilov SP (2018) En bloc holmium laser enucleation of the prostate (HOLEP EN BLOC): our experience. Urologiia 3:83–87CrossRefGoogle Scholar
  28. 28.
    Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR (2006) A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 50(3):569–573CrossRefGoogle Scholar
  29. 29.
    Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568CrossRefGoogle Scholar
  30. 30.
    Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A (2006) Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of > 40 g. BJU Int 97(1):85–89CrossRefGoogle Scholar
  31. 31.
    Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol 25(8):1347–1352CrossRefGoogle Scholar

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

Personalised recommendations