MP20-15 Efficacy, Efficiency, and Safety of En-bloc vs. Three-lobe Enucleation of the Prostate: A Propensity Score-Matched Analysis

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-15 Efficacy, Efficiency, and Safety of En-bloc vs. Three-lobe Enucleation of the Prostate: A Propensity Score-Matched Analysis Alexander J. Tamalunas, Leo F. Stadelmeier, Melanie Schott, Patrick Keller, Michael Atzler, Benedikt Ebner, Martin Hennenberg, Christian G. Stief, and Giuseppe Magistro Alexander J. TamalunasAlexander J. Tamalunas , Leo F. StadelmeierLeo F. Stadelmeier , Melanie SchottMelanie Schott , Patrick KellerPatrick Keller , Michael AtzlerMichael Atzler , Benedikt EbnerBenedikt Ebner , Martin HennenbergMartin Hennenberg , Christian G. StiefChristian G. Stief , and Giuseppe MagistroGiuseppe Magistro View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess efficacy, efficiency and safety in holmium laser enucleation of the prostate (HoLEP), we directly compared intraoperative performance, postoperative outcomes, and safety in the original three-lobe enucleation technique with the more recent en-bloc method. As HoLEP is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), detailed understanding of its benefits is mandatory. METHODS: We conducted a retrospective, propensity score-matched analysis of 1,396 men who underwent HoLEP for LUTS/BPO between 2017 and 2020. We included 606 patients in the final analysis (en-bloc n=303; three-lobe n=303), who were matched for prostate size, age, body mass index (BMI), and preoperative international prostate symptom score (IPSS). Patients were then stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes. RESULTS: While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly less adverse events (Clavien-Dindo classification ³II vs <II) for patients receiving en-bloc enucleation. Additionally, en-bloc enucleation was more efficient i.e., less than half of total laser energy (kJ) (Figure 1A), twice shorter enucleation time, and surgical performance (g/kJ/min) significantly increased 4-fold with prostate volume, compared to three-lobe enucleation (Figure 1C). CONCLUSIONS: While HoLEP in general is a safe and effective procedure, en-bloc enucleation techniques offer better surgical performance. Here, we demonstrate convincing data that the en-bloc-approach indeed provides a faster and more efficient way for enucleation and morcellation. However, in the end surgeons must feel comfortable with their basic technique. After mastering the three-lobe technique surgeons must decide whether to advance their skillset or rely on the tried-and-trusted strategy. However, the main objective needs be a good and safe treatment for patients. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e325 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander J. Tamalunas More articles by this author Leo F. Stadelmeier More articles by this author Melanie Schott More articles by this author Patrick Keller More articles by this author Michael Atzler More articles by this author Benedikt Ebner More articles by this author Martin Hennenberg More articles by this author Christian G. Stief More articles by this author Giuseppe Magistro More articles by this author Expand All Advertisement PDF downloadLoading ...