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Sources of Funding: None

Introduction

HoLEP (Holmium Laser Enucleation of the Prostate) is a safe and effective procedure for BPO treatment. Six years ago we modified the traditional 3-lobe technique into the so-called en-bloc no-touch approach, characterized by the enucleation of the adenoma in one single horshoe-like piece (en-bloc), largely exploiting the vaporizing plasma bubble generated around the tip of the laser fiber at a short distance from the tissue (no-touch). After more than 250 procedures with the 100-120W holmium laser device, in 2015 we chose to apply a low-power approach to deliver less energy to the capsular plane, and possibly minimize postoperative dysuria. The aim of the present work was to assess the feasibility of the low-power approach, and to compare its outcomes in terms of safety and efficacy with those of the traditional high-power HoLEP.

Methods

316 patients suffering from BPO (any prostate volume, normal PSA, Qmax <15 ml/sec, IPSS>10, PVR <300 cc) underwent en-bloc no-touch HoLEP in our Department. From January 2012 to May 2015 214 consecutive patients underwent high-power HoLEP (group 1) with the 100-120W Versapulse holmium laser (Lumenis), 2J energy setting, 50 Hz, 100W power. From June 2015 to June 2016 102 consecutive patients underwent low-power HoLEP (group 2) with the 120W Versapulse holmium laser (Lumenis) for the first 20 patients, then the 50W Auriga XL holmium laser device (Boston Scientific), both 2.2J energy setting, 18 Hz frequency, long pulse length, almost 40W power. Patients demographics and clinical data were prospectively registered. Data were correlated using the Pearson correlation test.

Results

Mean age (69.4 years +/- 7.5 d.s. vs. 67.7 years +/- 8 d.s.) and adenoma weight (55 g +/- 39 d.s. vs. 46 +/- 36 d.s.) were similar in both groups. Energy used in Group 2 (53 kJ +/- 23 d.s.) was 1/3 less than in Group 1 (83.5 kJ +/- 32 d.s.). Enucleation time (31 min +/- 13 vs. 27.5 +/- 15), efficiency (1.64 g/min +/- 0.8 vs. 1.7 +/- 1) and morcellation time (9 min +/- 7.6 vs. 7.7 +/- 7.1) were equivalent. Pre- and postoperative IPSS (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.), incidence of postoperative bleeding (no blood transfusions)(4.2% vs. 3%) and recatheterizations (4.2% vs. 3%) were similar. Long-lasting incontinences of variable entity (mainly mild) were similar (1.4% vs. 1.6%), as well as the incidence of postoperative dysuria (10%) at 3-month follow up.

Conclusions

Low-power en-bloc no-touch HoLEP is feasible, safe and effective as the high-power approach, in the hands of experienced operators, being energy consumption reduced by nearly one third.

Funding

None