Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology

MP6-2 - Comparation of 3 Different Techniques of Holmium Laser Enucleation of Prostate (HoLEP); Does Enucleation Technique Effect Peroperative and Postoperative Results?

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

3 different enucluation techniques were defined and effect of different techniques on operation time and postoperative results have been evaluated.


Methods :

174 Holmium laser enucleation of prostate cases were included to the trial, performed by two senior surgeons with more than 400 HOLEP experience. All patients were evaluated for age, preoperative PSA, prostate size, maximum flow rate(Qmax) postvoid residual volume(PVR) preoperatively, enucleation time, morcellation time and morcellated prostate volume peroperatively. 100 watt Holmium laser was used in all procedures. 3 different enucleation techniques were performed and patients were divided to groups accordingly; In enblock enucleation, all lobes were enucluated all together. In bilober retrograde low tension  technique, one lateral lobe and median lobe was enucluated first and remaining lateral lobe was enucleated afterwards. In trilober technique, lateral lobes and the median lobe was enucleated separately. Postoperatively, catheterisation and hospitilization duration, transient urine leakage rates, urethral strictures, postoperative Qmax&PVR and complications were evaluated. Transient urine leakage was defined as urine leakage persistant more than 24 hours after catheter removal but not more than 1 months. Kruskal-Wallis test and chi square tests were used for statistical analysis.


Results :

Overall 174 patients who underwent HOLEP between January 2012 to June 2016 were included to the trial. Mean age was 70.52(52-85). Baseline data were comparable between groups. Catheterisation time and hospitilization duration was comparable between groups.(median; 2 days and 5 days, respectively). Enucleation time was significantly shorter in Retrograde Low Tention (RLT) bilober technique (51.67 min vs 59.27 and 61.38 min; Enblock and Trilober, respectively, p=0.047). Morcellation time was comparable between groups(0.626). No significant difference was observed in morcellated prostate volume. Significant improvement in Qmax and PVR was noted in all groups(p<0.001).Transient urine leakage was significantly increased in enblock technique(p=0.042). Permanent incontinence and postoperative stricture rates were similar between groups(p=0.614)


Conclusions :

Three different enucleation techniques has been compared in this trial and to our knowledge this is the first clinical trial comparing different HOLEP enucleation techniques. Enucleation time was found significantly shorter in bilober RLT technique. Even though stricture rates and permanent urinary incontinence was similar between groups, enblock technique was found associated with increased transient incontinence.

Önder Yaman

Professor of Urology
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Ankara, Ankara, Turkey

Onder Yaman, MD, FEBU, FECSM, Professor of Urology
o In 1989, worked as a intern for 2 months at Bangour General Hospital, Edinburgh/Scotland Deparment of Plastic Surgery, and in 1990 at St.Johannsspital, Salzburg/Austria Department of Urology / Andrology for 1 month.
o Graduated from Ankara University, Medical Faculty
o In1995 worked as "visiting physician" at Detroit Wayne State University Department of Urology, USA
o In 1996 he has finished his residency and worked as specialist of Urology; In February 2000, he has become a associate professor at Ankara University, Medical Faculty, Department of Urology.
o Between 2000-2001 he participated to "Andrology Travelling Fellowship" programme at University of Illinois, Department of Urology - Andrology in Chicago, USA
o In Juanuary 2008 he was promoted to professor of Urology at Ankara University, Medical Faculty, Department of Urology. Since than he has been working at the same position.
o Between 2002-2015 he has worked at Turkish Andrological Association Administration Committee
o Between 2009-2011 worked as the president of Turkish Andrological Association
o Between 2011-2015 worked at Turkish Urological Association Administration Committee and he worked as associated general secretary
o Between December 2015 - December 2017, worked as the president of Turkish Urological Association Administration Committee
o Since December 2017, he works as the president of Turkish Urology Board Committee.
o Between 2011-2015, he has worked as Turkish Journal of Urology Chief Editor
o 2014 he deserved the get the title "Fellow of the European Committee of Sexual Medicine: (FECSM)"
o Between 2014 - 2017 worked at European Society of Sexual Medicine administration committee
o Since 2018- he has been working as aEAU Section of Andrological Urology (ESAU) Affiliated Board Member
o He has more than 80 studies published in peer-reviewed international journals and more than 1500 citations. (h index:23 ; i10 index:44)

Zafer Tokatlı

Department of Urology, Doruk Hospital Ankara, Turkey.
Ankara, Ankara, Turkey

Barış Esen

Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Ankara, Ankara, Turkey

Remzi Sağlam

Department of Urology, Medicana International Hospital, Ankara, Turkey.
Ankara, Ankara, Turkey