MP04-13: One-lobe-technique provides superior surgical efficiency compared to three-lobe-technique for Holmium Laser Enucleation of the Prostate (HoLEP)

Thilo Westhofen*, Alexander Buchner, Boris Schlenker, Patrick Keller, Melanie Schott, Michael Atzler, Christian G. Stief, Giuseppe Magistro, Munich, Germany

Introduction: Although Holmium Laser Enucleation of the prostate (HoLEP) has gained wide acceptance in surgical treatment for LUTS due to BPO, only sparse evidence on the advantage of different surgical techniques can be found. We aimed to compare the initially developed three lobe technique (TL) to the more recently described one-lobe technique (OL) regarding surgical efficiency.

Methods: A retrospective analysis of 1475 patients who underwent HoLEP for LUTS due to BPO at a large urological department between January 2017 and June 2020 was performed. Propensity score matching was conducted, resulting in a matched cohort of n=528 (n=264 underwent HoLEP in three-lobe-technique (TL), n=264 underwent HoLEP in one-lobe technique(OL)). Primary endpoint was surgical efficiency of the procedure. Secondary endpoint was perioperative outcome, early functional outcome and perioperative complications (according to Clavien Dindo).

Results: Baseline patient characteristics did not significantly differ between both cohorts. With comparable median prostate volume (PV) (108.5cc vs 105.0cc; p=0.858) tissue retrieval percentage did not significantly differ (72.9% vs 71.9%; p=0.114). Median surgery time (52.0min vs 83.5min; p<0.001), enucleation time (18.0min vs 35.0min; p<0.001) and morcellation time (9.0min vs. 12.0min; p<0.001) were significantly shorter for OL compared to TL. Surgical efficiency was furthermore shown to be in favour for OL with respect to laser energy applied (40.1kJ vs 76.1kJ; p<0.001), surgery speed (1.50gr/min vs. 0.89gr/min; p<0.001), enucleation speed (4.29gr/min vs. 2.19gr/min; p<0.001), enucleation efficiency (2.0gr/kJ vs. 0.9gr/kJ; p<0.001) and surgery performance (0.037gr/kJ/min vs. 0.011 gr/kJ/min; p<0.001). Applying Pearson Correlation, OL showed a significantly higher Correlation of PV to enucleation efficiency than TL (p < 0.001). With increasing PV enucleation efficiency and surgery performance for OL significantly increased (p < 0.001), whereas for TL, enucleation efficiency and surgery performance reached a plateau. Early functional outcome in terms of change in IPSS and Qmax were significantly better after OL (each p<0.05). No difference was found regarding adverse events (p=0.485)

Conclusions: One-lobe technique is faster, and more efficient than classical three-lobe technique. In contrast to TL, OL showed constantly enhanced surgical efficiency with increasing PV. OL therefore is a valuable alternative especially for giant prostates.

Source of Funding: none