En-Bloc Technique With Anteroposterior Dissection Holmium Laser Enucleation of the Prostate Allows a Short Operative Time and Acceptable Outcomes

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

“…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.…”

“…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.…”

“…Minagawa et al [26] enucleated the prostatic adenoma en bloc using a similar method to the anteroposterior dissection technique performed by Endo et al [22]. First, an incision is made on both sides of the verumontanum to lift both lateral lobes from the apex.…”

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

“…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.…”

“…The verumontanum was a very important landmark in traditional HoLEP technique, as the 12° incision was cut down into the mucosa ventrodorsally for the lateral lobe (El‐Hakim & Elhilali, 2002; Fraundorfer & Gilling, 1998; Kuo et al, 2003). However, in anatomical anterior–posterior dissection with early release/ dissection of the mucosa (Kim, Lee, et al, 2015; Miernik & Schoeb, 2019; Minagawa et al, 2015) (Gomez Sancha et al, 2015; Saitta et al, 2019; Scoffone & Cracco, 2016), the dissection allows to spare the sphincter zone from denudation of mucosa (Dorschner & Stolzenburg, 1994). The time of re‐epithelisation of the sphincteral mucosa could be interpreted as the time lag for reversible early stress urinary incontinence (ESUI).…”