1114 Safety and Efficacy of Enbloc Low-Power HoLEP for Large Prostate Glands: A Single Centre Prospective Series

Abstract

Abstract Aim HoLEP is the preferred technique for management of prostates >80cc in men with lower urinary tract symptoms. While evidence has shown that Low-Power (LP) HoLEP is comparable to High-Power HoLEP, the use of LP-HoLEP in enbloc enucleation for large prostates has not been demonstrated. We report a prospective series assessing the safety and feasibility of the technique. Method Data was prospectively collected on 105 patients who underwent LP-HoLEP from 12/02/2020 to 17/08/2022. A 50W Ho:YAG laser was used at 39.6W (2.2J, 18Hz). Prostate volume and uroflowmetry were assessed preoperatively, and patients were reviewed at three and 12 months postoperatively. Results The mean age of participants was 72 years with a median prostate volume of 117cc. Median enucleation time was 39 minutes, with a median enucleated weight of 73.0g and a median enucleation efficiency of 2.1g/min. Of the 105 patients, 60% were discharged on the same day with 94.3% of patients home by Day 1. Mean IPSS and QoL scores improved from 20.8 to 8.5 (p<0.001) and 4.2 to 2.0 (p<0.001) respectively. Qmax improved by 16.7ml/s (p<0.001) and post-void residual volume reduced by 144.8mL (p<0.001). Complications occurred in 27 (25.7%) patients [Clavien-Dindo 1: n = 23; 2: n = 2; 3A: n = 0; 3B: n = 2]. Conclusions In the hands of an experienced operator, enbloc LP-HoLEP is technically feasible and effective for the treatment of large prostates which can be delivered safely as a daycase procedure.