‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia

Saitta, Giuseppe; Becerra, José Ernesto Aguayo; Álamo, J. Fernández Del; González, Luis Llanes; Elbers, Javier Reinoso; Suardi, Nazareno; Sancha, Fernando Gómez

doi:10.1007/s00345-019-02671-4

Cited by 97 publications

(50 citation statements)

References 29 publications

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“…Over the years, many modifications have been developed, and the original surgical technique has evolved considerably [222324]. The en bloc nucleation is a method of enucleating the three prostatic lobes from the prostatic capsule as a whole lump, and several en bloc enucleation methods have emerged worldwide since 2010 [2526272829]. The en bloc method was developed to maintain the prostatic capsule plane and the urethral sphincter while removing the prostate without leaving residual prostate tissue.…”

Section: Historical Considerationsmentioning

confidence: 99%

“…Since 2010, several en bloc methods have emerged; these methods differ depending on whether the longitudinal incision is applied to the prostatic adenoma [2526272829]. Furthermore, there are differences in the methods of apical mucosal incision, as well as the handling of anterior prostate tissue at the apical 12 o'clock position.…”

Section: En Bloc No-touch Eucleation By the Turin Groupmentioning

confidence: 99%

“…Saitta et al [28] set the starting point of enucleation at an anterior apex. The mucosal incision starts from the 11 o'clock position to the 1 o'clock position of the prostatic apex, located proximal to the sphincter edge.…”

Section: En Bloc Enucleation With Early Apical Release By the Milan Gmentioning

confidence: 99%

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Current surgical techniques of enucleation in holmium laser enucleation of the prostate

2019

Investig Clin Urol

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Holmium laser enucleation of the prostate (HoLEP) has been accepted as the most efficient method of transurethral surgery for benign prostatic hyperplasia. The originally developed three-lobe technique has popularized this surgery; this method is based on three longitudinal incisions, by which the median lobe is removed, and subsequently, both lateral lobes are enucleated. To maintain a consistent surgical plane and to minimize sphincteric damage, the traditional three-lobe technique is continuously being refined and evolving. A few modifications of the original technique have been developed, and several en bloc enucleation methods have been introduced. However, more clinical evidence is required to show the superiority of newer techniques over the original three-lobe technique in terms of efficacy and long-term side effects. To date, none of the newer techniques have been accepted as a standard technique for HoLEP.

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Section: Historical Considerationsmentioning

confidence: 99%

Section: En Bloc No-touch Eucleation By the Turin Groupmentioning

confidence: 99%

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Current surgical techniques of enucleation in holmium laser enucleation of the prostate

2019

Investig Clin Urol

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“…Entire transitional zone enucleation aka en bloc AEEP/ EEP like in open prostatectomy has been popularised mainly by 3rd generation HoLEP promoters and has picked up momentum since. The overarching principle of all approaches using either Ho:YAG or Tm:YAG lasers is anatomical preparation, anterior–posterior dissection, early release of the ventral mucosa and apical mucosa sparing incisions in order to reduce early postoperative incontinence (Gomez Sancha et al, 2015; Kim, Lee, et al, 2015; Miernik & Schoeb, 2019; Minagawa, Okada, Sakamoto, Toyofuku, & Morikawa, 2015; Saitta et al, 2019; Scoffone & Cracco, 2016) and ease the learning curve by achieving several reproducible quality markers (Pentafecta) (Peyronnet et al, 2017). However, comparative assessment of effectivity is inconclusive.…”

Section: Surgical Resultsmentioning

confidence: 99%

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective

Herrmann

Wolters

2020

Andrologia

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Rome ne fu pas faite toute en un jour (Tobler, 1895). In the world of Endourology, the fact that good things need time to ripen was fully proven by evolution of Endoscopic Enucleation of the Prostate (EEP). This term was introduced in the 2016 update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS) with the reception of two meta-analysis (Gratzke et al., 2015; Li et al., 2015; Lin et al., 2015), promoting EEP for the first time as the preferred treatment of choice for the treatment Benign Prostatic Obstruction (BPO) of large volume prostatic glands. This resulted in the change of

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“…This may reduce sphincter damage and subsequent post‐operative dysuria and incontinence (both in terms of intensity and duration) (Scoffone et al, 2018; Scoffone, Figueiredo, & Cracco, 2019). Saitta and Gomez‐Sancha et al have described very low rates of transient stress incontinence using another approach for early apical release: the ‘white line’ (Saitta, 2019). Our ‘progressive cut’ laterally and ‘anterior reference point’ provide a clear reference for beginners and facilitate this early incision.…”

Section: Discussionmentioning

confidence: 99%

Holmium laser enucleation of the prostate: Problem‐based evolution of the technique

Figueiredo

Cracco²,

Marins

et al. 2020

Andrologia

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Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive and sizeindependent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. Considered difficult to learn, different modifications of the technique have been proposed in the last 21 years to overcome the most common problems encountered during this procedure. We present a step-by-step technique including the reasons and advantages of each modification we have progressively adopted until we evolved into our totally en-bloc no-touch low-power HoLEP.

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‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia

Cited by 97 publications

References 29 publications

Current surgical techniques of enucleation in holmium laser enucleation of the prostate

Current surgical techniques of enucleation in holmium laser enucleation of the prostate

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective

Holmium laser enucleation of the prostate: Problem‐based evolution of the technique

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