Efficacy, efficiency, and safety of en-bloc vs. three-lobe enucleation of the prostate: a propensity score-matched analysis

Abstract

Objective: To assess efficacy, efficiency, and safety in holmium laser enucleation of the prostate (HoLEP), we directly compared intraoperative performance, postoperative outcomes, and safety in the original three-lobe enucleation technique with the more recent en-bloc method.Methods: Retrospective, propensity score-matched analysis of 606 men who underwent HoLEP for LUTS/BPO. Patients were stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes.Results: While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly less adverse events (Clavien-Dindo classification >/=II vs < II) for patients receiving en-bloc enucleation. Additionally, en-bloc enucleation was more efficient i.e., less than half of total laser energy (kJ), twice shorter enucleation time, and surgical performance (g/kJ/min) significantly increased 4-fold with prostate volume, compared to three-lobe enucleation.Significance: While HoLEP in general is a safe and effective procedure, en-bloc enucleation techniques offer better surgical performance.