MP04-12: En-Bloc enucleation technique with early apical release and urinary sphincter preservation using Pulse modulation (Virtual Basket) vs En-Bloc HoLEP

Moises Elias Socarras*, Javier Reinoso Elbers, Fabio Esposito, Isabella Greco, Julio Fernandez del Alamo, Vanesa Cuadros Rivera, Diego Carrion Monsalve, Juan Gomez Rivas, Luis Llanes Gonzalez, Luis Llanes Gonzalez, Fernando Gomez Sancha, Madrid, Spain

Introduction: Pulse modulation represents one of the important advances in holmium lasers in recent years. We aimed to assess the feasibility, efficacy, safety and outcomes of En-Bloc technique with early apical release using pulse Modulation (Virtual Basket) and compare with En Bloc HoLEP.

Methods: n=261 patients underwent En Bloc enucleation of prostate (n= 126 En Bloc HoLEP using Pulse modulation (Virtual Basket) were compared with n=135 patients in En Bloc HoLEP group. Procedures were performed by a large experienced single surgeon in laser surgery for BPE (>5000 procedures), using the Cyber Ho 150W Holmium laser (Quanta SystemSpA). Setting 2 J/ 50 Hz, with Virtual Basket (VB) activated during enucleation time and 1.2J/40 Hz with Bubble Blast (BB) for hemostasis time. Intra- and post-operative parameters as well as functional results were assessed: prostate volume, Q max, PVR, PSA, IPSS, surgical time, enucleation time, ablation rate, length of hospitalization and complications according to Clavien Dindo. Both (VB & BB) are double pulse modulation effects, Virtual Basket provides excellent cutting, dissection and coagulation balance; while Bubble Blast is useful for coagulation time.

Results: Median patient age was 66.5 ± 8.6 and 65.30 ± 7.95, prostate volume 80.57 ± 39.34 and 77.75 ± 39.25, PSA 4.55 ± 0.99 and 4.15 ± 0.75 for En Bloc Holep using Virtual basket and En Bloc HoLEP respectively. Surgical time (37.32 ± 11.9 vs 48.35 ± 19.3), enucleation time (24.97 ± 7.4 vs 32.75 ± 13.08), ablation rate (3.87 ± 1.35 vs 1.65 ± 0.77 gr/min) and haemostasia time (2.36 ± 2.35 vs 8.13 ± 4.39) were significantly better for En Bloc HoLEP using Virtual basket (All p< 0.001).  Q max, PVR, PSA and IPSS showed significant improvement. No complications Clavien Dindo II – III were observed in En Bloc HoLEP using virtual basket group.

Conclusions: En-Bloc HoLEP with early apical release using pulse modulation is feasible, safe and effective to treat patients affected by BPE

Source of Funding: None