Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm?

Holmium laser enucleation of the prostate (HoLEP) is considered a safe and effective treatment in case of bladder outlet obstruction (BOO). Despite technical execution has evolved over time, from the standard to the more recent approaches, data comparing these two techniques are missing. The aim of the present study was to describe our HoLEP with technique and compare peri- and postoperative results with the classical approach in a single referral center. We prospectively analyzed all consecutive cases between 2017 and 2019 divided according to the type of approach. Patients were preoperatively studied through instrumental assessment and clinical evaluation, using validated questionnaires and then postoperatively at specific time frames. Linear regression analysis was performed to evaluate possible predictor of continuous variables. All the procedures were carried out by one single expert surgeon. Overall, 168 patients were included, of which 81 were treated with classical and 87 with with technique. The two cohorts were comparable related to preoperative features and postoperative complication rate. Mean enucleation time (ET), lasing time, amount of energy delivered, and overall operative time were significantly lower in procedures ( < 0.05). Stepwise multivariable linear regression showed that strategy can significantly predict shorter ET and lower energy delivered. Stress incontinence rate at 1-month follow-up was found to be significantly reduced in the group, compared with the counterpart. Both techniques are effective and safe treatment options for BOO, since peri- and postoperative surgical and functional outcomes were favorable. strategy may significantly decrease ET and the amount of energy delivered leading to a reduced early stress incontinence rate compared with the standard approach.