Abstract Objective: To compare en-bloc HoLEP with conventional lobe-by-lobe (LBL) HoLEP technique in terms of surgical efficiency, perioperative outcomes, and early continence recovery through a randomized controlled trial. Patients and Methods: This single-center randomized controlled trial included patients with prostate volumes > 80 mL undergoing HoLEP for bladder outlet obstruction secondary to benign prostatic hyperplasia. Eligible patients were randomized to either en-bloc or LBL HoLEP. All procedures incorporated early apical release and sphincteric mucosal preservation. Assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. primary outcome was enucleation efficiency (resected weight/enucleation time). Secondary outcomes included operative efficiency, laser energy use, blood loss, hospital stay, complications, and functional outcomes (IPSS, QoL, Qmax, PVR, and transient stress urinary incontinence SUI). Results: A total of 123 patients were randomized (en-bloc: 60; LBL: 63). En-bloc HoLEP was associated with shorter enucleation time (62.5 vs. 74.3 min, P = 0.02), operative time (78.6 vs. 94.9 min, P = 0.0007), and lower laser energy use (135 vs. 154 KJ, P = 0.014). Enucleation efficiency was comparable (1.25 ± 0.49 vs. 1.17 ± 0.62 g/min; P = 0.42). Both techniques resulted in significant postoperative improvements in IPSS, QoL, Qmax, and PVR (all P < 0.0001). Complication rates were similar (14.6% vs. 14%; P = 0.8). At 3 months, transient SUI rates were low and comparable (3.8% en-bloc vs. 4% LBL; P = 0.3). Conclusion: En-bloc HoLEP reduces enucleation time, operative time, and laser energy consumption compared to LBL HoLEP, while maintaining comparable safety, efficacy, and early continence outcomes when performed with modern technical refinements.
Laymon et al. (Fri,) studied this question.