En-bloc holmium laser enucleation of the prostate (HoLEP): Initial experience and consolidation of the technique

Abstract

Introduction and objectives

Benign prostatic enlargement has a prevalence of approximately 60% in 60-year-old men. En bloc enucleation and its variants, which emerged in 2010, are methods to enucleate the three lobes of the prostatic capsule completely, maintaining the capsular plane and the urethral sphincter while removing the prostate. The aim of the present study is to analyze the implementation of the surgical technique, considering the learning curve and the experience accumulated in a group of patients before and after its development.

Material and methods

Retrospective study from July 2022 to November 2024, in which 136 patients with lower urinary tract symptoms due to prostate growth with indication for surgical treatment were included. Bleeding, surgical time, hospital stay, enucleated prostate volume, as well as enucleation, morcellation, time and laser energy efficiencies were analyzed.

Results

The efficacy of the procedure was higher in the post-curve group with a p < 0.0001 compared to the pre-curve group with a coefficient of determination R² = 0.8091. Enucleation efficiencies, laser time and energy showed a statistically significant difference (p < 0.05) in favor of the post-curve group.

Conclusions

Holmium laser enucleation of the prostate has proven to be an effective and safe surgical treatment, even during the learning curve. The turning point of the procedure depends on proper mentoring and the appropriate selection of cases during the training process.