Laser-Driven Dissection Achieves Earlier Continence Recovery Than Blunt Dissection During Holmium Laser Enucleation of the Prostate

Abstract

Objectives

During holmium laser enucleation of the prostate (HOLEP), blunt dissection (BD) by pushing the tip of the scope may exert mechanical force on the sphincter that could be avoided by adopting laser dissection (LD). This study evaluates the continence recovery in consecutive patients who underwent BD and LD.

Methods

A prospective cohort of patients who underwent LD was compared with a retrospective control that underwent BD. In both groups, early apical release was performed, and the adenoma was split at 12 O'clock after complete enucleation. In LD, a trans-capsular plane was sharply created by LD and is guided by the circular capsular fibers. A mechanical push with the resectoscope tip was used to create and maintain the ideal surgical plane in the BD group while the laser energy was used to achieve timely hemostasis. The primary outcome was stress urinary incontinence (SUI), defined as the need to use any number of pads, immediately after catheter removal, at 1 week and 1 month postoperatively.

Results

Consecutive 51 (48.6%) and 54 (51.4%) patients underwent BD and LD, respectively. The LD group tends to be older while other demographics were comparable. Both groups were comparable regarding the estimated prostate volume, enucleation time, and postoperative resolution of symptoms. Continence recovery was in favor of the LD group immediately after removing the catheter (77.8% vs. 43.1%; p < 0.001), at 1 week (92.6% vs. 66.7%; p = 0.002), with no significant difference at 1 month (98.1% vs. 88.2%; p = 0.06).

Conclusions

LD tends to have favorable early continence recovery compared with BD mostly because of less mechanical stress. Minimizing the periods of blunt pushes during the enucleation might benefit continence recovery.