Comparison of En-bloc Vs. Three-lobe Techniques of Holmium Laser Enucleation of Prostate (HOLEP): A Single Center Experience

Abstract

Background: Holmium laser enucleation of the prostate (HOLEP) surgery has played a significant role in the treatment of benign prostatic hyperplasia. Since the definition of the classical three-lobe technique, many new techniques have been introduced. We aimed to compare the efficacy and safety of the en bloc and three-lobe techniques used in this surgery. Material and Methods: Medical data of 80 patients who underwent HoLEP surgery at a tertiary center were evaluated retrospectively. The patients were divided into 2 groups (en-bloc: 40, three-lobe: 40). All patients were evaluated for age, preoperative PSA, prostate size, maximum flow rate (Qmax), enucleation time, morcellation time, enucleated tissue weight, enucleation time efficacy (enucleated weight/enucleation time), morcellation time efficacy (enucleated weight/morcellation time), perioperative and postoperative complications and incontinence status. Results: There was no significant difference between the two groups in terms of age, PSA, and preoperative uroflowmetry results. 8 patients in the en-bloc group and 11 patients in the three-lobe group had a catheter preoperatively. Enucleation time was significantly shorter in the en-bloc group (p<0.001), while morcellation time was similar (p=0.706). Although the prostate volume was higher in the three-lobe group (p=0.013), no difference was observed in terms of enucleated tissue weight (p=0.261). Postoperative uroflowmetry results were similar in the two groups (p=0.628). Postoperative hematuria was observed in 2 patients in the en-bloc group and 4 patients in the three-lobe group. Prolonged incontinence developed in 6 patients in the en-bloc group and in 7 patients in the three-lobe group. No statistically significant difference was observed between the two groups in terms of complications. Conclusion: In reviewing the results of our study, we observed that both techniques yield comparably satisfactory outcomes and similar rates of late complications. However, the en-bloc technique demonstrates a significantly shorter enucleation time as well as a reduced overall operative duration.

Keywords

• En-bloc
• Three-lobe
• HOLEP
• Complication
• Benign prostate hyperplasia

Ethical Statement

This study was approved by the Local Ethics Committee of Kartal Dr. Lütfi Kirdar City Hospital (approval no: 2024/010.99/7/14, date: August 28, 2024).

Holmium Laser Prostat Enükleasyon (HOLEP) Cerrahisinde En-bloc ve Three-lobe Tekniklerinin Karşılaştırılması: Tek Merkez Sonuçlarımız

Abstract

Amaç: Holmium lazer prostat enükleasyon (HOLEP) cerrahisi, benign prostat hiperplazisi tedavisinde önemli bir rol oynamaktadır. Klasik three-lobe tekniğin tanımlanmasından sonra, çok sayıda yeni teknik literatüre sunulmuştur. Bu çalışmada, en-bloc teknik ile three-lobe tekniğin etkinlik ve güvenilirliğini karşılaştırmayı amaçladık. Materyal ve metod: 3. basamak bir merkezde, HoLEP cerrahisi uygulanan 80 hastanın verileri retrospektif olarak incelendi. Hastalar 2 gruba ayrıldı (en-bloc:40, three-lobe:40). Tüm hastaların yaş, preoperatif PSA, prostat hacmi, maksimum akış hızı (Qmax), enükleasyon süresi, morselasyon süresi, enükleasyon etkinliği (çıkarılan doku/enükleasyon süresi), morselasyon etkinliği (çıkarılan doku/morselasyon süresi), peroperatif ve postoperatif komplikasyonları kaydedildi. Bulgular: İki grup arasında yaş, PSA ve operasyon öncesi üroflowmetri sonuçları açısından farklılık saptanmadı. Operasyon öncesinde, en-bloc grubunda 8 ve three-lobe grubunda 11 hastada üretral kateter mevcuttu. Enükleasyon süresi en-bloc grubunda istatistiksel olarak daha kısa bulunurken (p<0,001), morselasyon süresi iki grupta da benzer bulundu (p=0,706). Preoperatif prostat hacmi three-lobe grubunda yüksek olmasına rağmen (p=0,013), iki grup arasında çıkartılan doku hacmi açısından anlamlı farklılık saptanmadı (p=0,261). Postoperatif üroflowmetri sonuçları açısından iki grup arasından farklılık saptanmadı (p=0,628). En-bloc grubunda 2, three-lobe grubunda 4 hastada postoperatif hematüri izlendi. En-bloc grubunda 6, three-lobe grubunda 7 hastada uzamış inkontinans tespit edildi. Total komplikasyon oranı açısından iki grup arasında anlamlı farklılık saptanmadı. Sonuç: Çalışmamızın sonuçlarını incelediğimizde, her iki tekniğin de benzer şekilde tatmin edici sonuçlar ve benzer geç komplikasyon oranları sağladığını gözlemledik. Ancak en-bloc tekniği, anlamlı derecede daha kısa bir enükleasyon süresi ve daha kısa toplam ameliyat süresi göstermektedir.

Keywords

• En-bloc
• Three-lobe
• HOLEP
• Komplikasyon
• Benign prostat hiperplazisi

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