Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes!

Abstract

Anatomical endoscopic enucleation of the prostate (AEEP) was first described by Haraoka (Haraoka, 1983). It was not until Fraundorfer and Gilling reported their initial experience with Holmium Laser Enucleation of the Prostate (HoLEP) in 1998 that the potential advantages of AEEP began to be appreciated (Fraundorfer & Gilling, 1998). AEEP differs from all other endoscopic procedures for benign prostatic obstruction (BPO) because it removes the entire benign prostatic hyperplasia (BPH) component of the prostate (Figure 1). A variety of energy sources can be used to perform AEEP, for example high power holmium (100 watts or more), low power holmium (70 watts or less), thulium, greenlight and diode lasers, as well as monopolar and bipolar diathermy. This paper summarises the advantages of AEEP compared to the other surgical techniques for BPO (resection and vaporisation).

A systematic review and meta-analysis of efficacy and safety comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for patients with prostate volume less than 100 mL or 100 g

“…There are several possible reasons for these differences between HoLEP and TURP. Firstly, TURP cuts blood vessels during each resection process, which causing bleeding, while HoLEP cuts the tissue along the potential gap of the prostate capsule, avoiding the blood vessels in the prostatic tissue; meanwhile, holmium laser can coagulate blood vessels while cutting and produce a tissue coagulation layer of about 3 mm, producing better hemostasis performance (34)(35)(36). Secondly, the pulse wavelength of the Ho: YAG laser is 2,140 nm, and the pulse energy can be absorbed by water during the endoscopic operation with normal saline irrigation, which only produces a penetration depth of 0.4 mm and has good safety (6,37).…”

Anatomical endoscopic enucleation of the prostate for bladder outlet obstruction: a narrative review

“…One of the most widely approved advantages of AEEP is its efficacy and safety in patients with large prostates [13]. A meta-analysis of three RCTs comparing HoLEP and SP reported similar enhancements in IPSS, QoL, Qmax, and PVR at both 12 and 24 months.…”

“…Level 1a demonstration recommends that AEEP furnishes at least equivalent, but possibly greater enhancements, in international prostate symptom score (IPSS), maximum urinary flow rates (Qmax), and post-void residual volumes (PVR) compared to those provided by vaporization and resection procedures [13].…”

“…While TURP procedure meets blood vessels with every swipe, AEEP merely meets blood vessels on the inner aspect of the peripheral zone (PZ), and perforates between transitional zone and PZ. RCTs and meta-analyses constantly present less bleeding, shorter catheter times and consequently shorter hospital stays for AEEP when compared to those for TURP [13]. A recent meta-analysis presented a lesser reduction in serum hemoglobin (-0.54 mg/dL, p < 0.005), fewer blood transfusions (odds ratio, 0.83; p < 0.005), shorter catheter times (-0.58 days, p < 0.05), and shorter hospital stays (-0.91 days, p < 0.005) after AEEP compared to those after resection procedures [3].…”

Quest for the best—A move to Anatomical Endoscopic Enucleation of the Prostate

“…Following the introduction from the historical and anatomical perspective (Reddy, Utley, & Gilling, 2020; Oh & Shitara, 2020), different techniques of AEEP by different energy source are illustrated (Ryang, Ly, Tran, Oh, & Cho, 2020; de Figueiredo, Cracco, de Marins, & Scoffone, 2020; Herrmann & Wolters, 2020; Rijo & Misrai, 2020). The surgical outcomes, with emphasis on postoperative continence and sexual functions, and complications of AEEP are summarised in the following chapters (Chen, Chung, Chu, Chen, & Ho, 2020; Lee, Cho, Juan, & Teoh, 2020; Cheng, Li, & Yu, 2020; Wei, Ke, Xu, & Xue, 2020) before a debate on AEEP as the next gold standard treatment for benign prostatic obstruction (Aho, Armitage, & Kastner, 2020; Wroclawski, Teles, & Carneiro, 2020). Finally, this Special Issue is rounded up by a discussion on surgical training (Teoh et al, 2020) and a survey on AEEP from urologists worldwide (Gudaru et al, 2020).…”