Advertisement

Postoperative dysuria after high- and low-power en-bloc no-touch HoLEP

Login to Access Video or Poster Abstract: MP02-11
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, exploiting the vaporizing effects of the plasma bubble generated around the tip of the laser fiber at a short distance from the tissue. Transient storage symptoms, mostly resolving spontaneously or with medical therapies within 1-3 months, are described among the early complications in 9-59% of patients who underwent HoLEP, and have been correlated also with energy consumption. The aim of the present study was to determine whether postoperative dysuria is somehow influenced by the use of a low-power approach rather than of a high-power one.

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) for the first 20 cases with the Versapulse holmium laser (Lumenis), 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. IPSS questionnaires were self-administered before surgery and at 3-month follow up, VAS evaluation 1 month after surgery.

Results

Age (range 51-87 years) and adenoma weight (range 10-200 grams) were similar in the two groups. Mean energy employed for enucleation was 83.5 kJ +/- 32 d.s. for group 1, 53.4 kJ +/- 23 d.s. for group 2 (p<0.01), with a kJ/g ratio 2 +/- 1 vs. 1.5 +/- 0.8. Mean enucleation time was equivalent (31 min +/- 13 d.s. vs. 27.5 min +/- 11 d.s.), mean enucleation efficiency too (1.64 g/min +/- 0.8 d.s. vs. 1.7 g/min +/- 1 d.s.). Pre- and postoperative IPSS were similar (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.). Postoperative dysuria had the same incidence (10%), but in group 2 mean VAS evaluation at 1-month follow up was significantly better (6.2 +/- 1.5 d.s. in group 1, 2.4 +/- 3 d.s. in group 2).

Conclusions

Low-power en-bloc no-touch HoLEP uses less energy than the high-power approach, with reduced kJ/g ratio and similar postoperative dysuria (10%), being intensity and duration of the storage symptoms reduced.

Funding

None

Authors
Cecilia Cracco
Manuela Ingrosso
Nicola Russo
Cesare Marco Scoffone
back to top