Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men greater than 70 affected. Historically, transurethral resection of the prostate (TURP) has been considered the historical gold standard in the treatment of LUTS due to BPH for many years, contemporary literature indicates that holmium laser enucleation of the prostate (HoLEP) has replaced TURP and open simple prostatectomy as  surgical gold standard for BPH treatment. This study was to evaluate the safety, efficiency, and size-dependency of ‘Inverted omega symbol En-bloc’ HoLEP in the treatment of BPH with LUTS.

716 consecutive patients who underwent HoLEP by a single surgeon using ‘Inverted omega symbol En-bloc’ HoLEP technique to treat bladder outlet obstruction from 2014 to 2021 were retrospectively analyzed. Patients were divided into group 1 (<40 cc, mean 29.1 cc, n=339), group 2 (40-<60 cc, mean 48.1 cc, n=216), group 3 (≤ 60 cc, mean 84.5 cc, n=161). Perioperative parameters, safety and functional outcomes were assessed and analyzed.

Mean ages, body mass index, and comorbid diseases of 3 groups were no significant difference but showed a significantly higher median PSA level in larger prostate sizes (p<0.01). Perioperative parameters, such as enucleation time (45.8 ± 26.9 min), morcellation time (13.2 ± 47.5 min), and catheterization duration (1.6 ± 1.2 day) were significantly differed in favor of smaller prostate sizes (p<0.01). The significant improvements of IPSS (total, voiding, storage, and quality of life), PVR, and Qmax were showed from 3 months after HoLEP, and continued during the 1-year follow-up period in all groups (p<0.01). Postoperative complications were urethral stricture (1.5%), bladder neck contracture (1.7%), urinary incontinence (2.0%), and bladder injury by morcellator (0.6%). Bladder neck contractures occurred only in group 1. Postoperative surgical managements for complications were urethral sounding (1.3%), endoscopic internal urethrotomy (EIU) (0.3%), and Re-HoLEP for bladder neck contracture (1.7%). And Re-HoLEP for regrowing adenoma were 15 (2.1%). Postoperative medications for more than 6 months were α-blocker (3.1%), cholinergics (2.2%), anticholinergics (8.1%), antidiuretics (2.5%), and daily PDE5 inhibitor (5.3%). Postoperative incidental prostate cancers were 34 (4.8%).

The significant improvements of IPSS (total, voiding, storage, and quality of life), PVR, and Qmax were showed from 3 months after HoLEP, and continued during the 1-year follow-up period in all size of prostaes (p<0.01).   Postoperative complications were also few and similar to those already reportted in other HoLEP studies.  Some complications could be resolved with surgical treatment such as EIU or Re-HoLEP..

‘Inverted omega symbol En-bloc’ HoLEP technique is safe and effective for the treatment of bladder outlet obstruction. And also, ‘Inverted omega symbol En-bloc’ HoLEP is a size-independent and effective method in all size of prostate.

Continence 2S2 (2022) 100419
DOI: 10.1016/j.cont.2022.100419