A randomized controlled trial comparing en-bloc vs lobe-by-lobe HoLEP: surgical efficiency and early continence outcomes.
Yahya H Elmorsy, Ahmed M Elshal, Ahmed R El-Nahas et al.
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In 30 seconds
This single-center randomized controlled trial compared en-bloc with conventional lobe-by-lobe (LBL) HoLEP in patients with prostate volumes >80 mL undergoing surgery for benign prostatic hyperplasia. Among 123 randomized patients, en-bloc HoLEP shortened operative time (78.6 vs. 94.9 min, P = 0.0007) and enucleation time, and used less laser energy. Enucleation efficiency, complication rates, postoperative functional improvements, and transient stress urinary incontinence at 3 months were comparable between techniques. Both approaches incorporated early apical release and sphincteric mucosal preservation.
Key findings
- Operative time was 78.6 vs. 94.9 min for en-bloc and LBL HoLEP, respectively (P = 0.0007).
- Enucleation time was 62.5 vs. 74.3 min (P = 0.02), and laser energy use was 135 vs. 154 KJ (P = 0.014).
- Enucleation efficiency was comparable: 1.25 ± 0.49 vs. 1.17 ± 0.62 g/min (P = 0.42).
- At 3 months, transient SUI rates were 3.8% vs. 4% (P = 0.3); complication rates were 14.6% vs. 14% (P = 0.8).
Why it matters
For patients with large prostates undergoing HoLEP, the en-bloc approach may improve procedural efficiency without an observed difference in safety, functional outcomes, or early continence in this trial. The findings help distinguish shorter operating time from enucleation efficiency, which was comparable, and place the continence results in the context of techniques that included sphincter-preserving refinements.
What to keep in mind
This was a single-center trial, and continence follow-up reported here was early, with the comparison specified at 3 months.