Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Urology
Published in: World Journal of Urology 11/2019

01-11-2019 | Stress Incontinence | Original Article

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

Authors: Giuseppe Saitta, José Ernesto Aguayo Becerra, Julio Fernández del Álamo, Luis Llanes González, Javier Reinoso Elbers, Nazareno Suardi, Fernando Gómez-Sancha

Published in: World Journal of Urology | Issue 11/2019

Login to get access

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.
Literature
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 2:1–8
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: 9780128113974
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):1030–1043PubMedCrossRef
4.
Gilling PJ, Fraundorfer MR (1998) Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol 8(1):11–15PubMedCrossRef
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):604–611PubMedCrossRef
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):408–411PubMedCrossRef
7.
Moody JA, Lingeman JE (2001) Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy. J Urol 165(2):459–462PubMedCrossRef
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):1926–1929PubMedCrossRef
9.
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):449–453PubMedCrossRef
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):151–153PubMedCrossRef
12.
Kelly DC, Das A (2012) Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol. 19(1):6131–6134PubMed
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):1105–1109PubMedCrossRef
14.
Baazeem AS, Elmansy HM, Elhilali MM (2010) Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 105(5):584–585PubMedCrossRef
15.
Scoffone CM, Cracco CM (2016) The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol 34(8):1175–1181PubMedCrossRef
16.
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):50–54PubMedCrossRef
18.
Hiraoka Y (1983) A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia. J Nippon Med Sch 50:896–898CrossRef
19.
Hiraoka Y, Akimoto M (1989) Transurethral enucleation of benign prostatic hyperplasia. J Urol 142:1247–1250PubMedCrossRef
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 74:102–107PubMedCrossRef
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):769–774PubMedPubMedCentralCrossRef
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):539–547PubMedCrossRef
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):1336–1340PubMedCrossRef
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):6PubMedPubMedCentralCrossRef
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):628–633PubMedCrossRef
26.
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 3:83–87CrossRef
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):569–573PubMedCrossRef
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):563–568PubMedCrossRef
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):85–89PubMedCrossRef
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):1347–1352PubMedCrossRef
Metadata
Title
‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia
Authors
Giuseppe Saitta
José Ernesto Aguayo Becerra
Julio Fernández del Álamo
Luis Llanes González
Javier Reinoso Elbers
Nazareno Suardi
Fernando Gómez-Sancha
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 11/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-019-02671-4

Other articles of this Issue 11/2019

World Journal of Urology 11/2019 Go to the issue

Topic Paper

Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?

Topic Paper

Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma

Original Article

Combined-modality 125J-seed-brachytherapy, external beam radiation and androgen deprivation therapy of unfavorable-risk prostate cancer: report of outcomes and side-effects

Original Article

Propensity-matched analysis of patient-reported outcomes for neoadjuvant chemotherapy prior to radical cystectomy

Original Article

A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills?

Original Article

Efficacy and safety of non-ablative vaginal erbium:YAG laser treatment as a novel surgical treatment for overactive bladder syndrome: comparison with anticholinergics and β3-adrenoceptor agonists