To report the initial experience and outcome of holmium laser enucleation of the prostate (HoLEP) by a en-bloc and bladder neck preserved technique in treating benign prostate hyperplasia (BPH).

A total of 1537 BPH patients who underwent HoLEP from February 2013 to March 2018 in this study. HoLEP was performed by the “en-bloc” enucleation technique. Resection was began at the level proximal to the verumontanum. After performing the initial resection, an anatomic plane was formed between the surgical capsule and hyperplastic gland. Using the shaft of the resectoscope and laser impulse, the plane was developed until the bladder neck. The same method was used for the lateral and middle lobes. The anterior fibrotic tissue was directly resected to the bladder neck until all the lobes were removed from the bladder neck. The bladder neck is usually opened first at the 11–1 o’clock position and then continuously resected on either side, carefully avoiding the penetration of the bladder neck at 5–7 o’clock position. After the resection, all the lobes dropped into the bladder. A morcellator with an offset nephroscopic lens was introduced, and prostate adenoma was morcellated under direct vision. Tissue shivers were removed by irrigation. Clinical data before and 6 months after the surgery were analyzed.

HoLEP were technically successful in all 1537 patients. The mean prostate volume was 72 ± 29 mL; mean total operative time and enucleation time for HoLEP were 77.8 ± 21.9 and 43.5 ± 15.4 min, respectively; and mean resected prostate weight was 54.3 ± 17.7 g. No transurethral resection of the prostate syndrome was observed during and after HoLEP. The estimated blood loss during HoLEP was 62.1 ± 23.7 mL, and no case required transfusion. International Prostate Symptom Score and postvoid residual volume significantly decreased (24.1 ± 2.84 vs 13.5 ± 3.39, P <0.001; 67.1 ± 30.8 vs 20.8 ± 8.8, P <0.001, respectively), maximal flow rate significantly increased (7.25 ± 1.42 vs 19.63 ± 16.56, P <0.001). Before operation, 152 patients had sexual activity and anterograde ejaculation, therein normal anterograde ejaculation presented in 128 patients postoperation, while 24 patiens (15.8%) felt no semen ejaculation.

HoLEP by a en-bloc and bladder neck preserved technique has the potential to obtain good functional outcome with small injury and high efficiency, especially for patients who need to preserve normal sexual function and anterograde ejaculation