Development of a Complete En-Bloc Technique with Direct Bladder Neck Incision: A Newly Modified Approach for Holmium Laser Enucleation of the Prostate

Introduction: The objectives of this study were to introduce a newly developed approach for holmium laser enucleation of the prostate (HoLEP) called the "complete en-bloc technique," and to compare the clinical outcomes of this approach with those of previously performed procedures. Methods: This study retrospectively assessed the perioperative findings from 548 patients with benign prostatic hyperplasia (BPH) undergoing HoLEP who were divided into the following groups according to the consecutive changes in surgical techniques: group A (n = 236), the three-lobe technique; group B (n = 137), the conventional en-bloc technique; and group C (n = 175), the complete en-bloc technique with direct bladder neck incision. Results: There were no significant differences in major clinical characteristics or urinary symptoms among groups A, B, and C. Although there was no significant difference in the resected prostate weight among the three groups, the enucleation time was significantly shorter and total laser energy was significantly lower in group C than in groups A and B. Therefore, the enucleation efficiency, calculated by dividing the resected prostate weight by the enucleation time, was significantly greater in group C than in groups A and B. Furthermore, no significant differences in the postoperative urinary symptoms, including the International Prostate Symptom Score (IPSS), quality of life, maximum flow rate, postvoid residual, and persistent stress urinary incontinence rate, were noted among the three groups, and there were no significant differences in the incidences of major perioperative complications, including the blood transfusion, bladder injury, urethral stricture, and bladder neck sclerosis among the three groups. Conclusions: These findings suggest that our complete en-bloc technique can improve the clinical outcomes of HoLEP in BPH patients, even in difficult cases, considering its markedly improved enucleation efficiency.