"Three horse shoe-like incision" holmium laser enucleation of the prostate: first experience with a novel en bloc technique for anatomic transurethral prostatectomy.

Abstract

To demonstrate the performance of a novel holmium laser enucleation technique in patients with lower urinary tract symptoms (LUTS). Between September 2015 and August 2017, 114 consecutive patients underwent modified HoLEP [3 horse shoe-like incision HoLEP (3 HSI HoLEP)] for LUTS performed by an experienced urologist (A.M.). The surgical intervention and short postoperative course were analyzed. International Prostate Symptom Score (IPSS), quality of life score, maximum urinary flow rate (Q max), postvoid residual urine (PVR), and clinical and sociodemographic data were assessed preoperatively. The patient cohort was compared with existing data regarding clinical outcome parameters after surgical LUTS therapy. The mean size of the prostatic gland was 86.3 ± 46.5mL. The mean total operative time was 49.6min (15-280min). IPSS, Q max, and PVR were 20.7, 10.8, and 112.7mL, respectively, prior to the intervention in the 3 HSI HoLEP group. The complication rate for Clavien category-III complications was 4.4%; no category IV complications were recorded. Seven of 114 patients experienced urinary retention after catheter removal during the hospital stay. The presented procedure provides several improvements over the standard modality. The prostatic gland is enucleated en bloc in an anatomical manner without longitudinal incisions of the urethra. This method is fast, safe, and may be easier to learn. However, this is the first description recorded. Future multicenter, controlled studies should clarify the long-term outcomes and surgical performance of 3 HSI HoLEP.