Comparison of En-bloc Vs. Three-lobe Techniques of Holmium Laser Enucleation of Prostate (HOLEP): A Single Center Experience

Authors : Erdinç Dinçer, Orkunt Özkaptan, Cengiz Canakcı, Utku Can, Tahsin Batuhan Aydoğan, Mehmet Burak Doğrusever

Pages : 800-805

Doi:10.35440/hutfd.1690946

View : 33 | Download : 104

Publication Date : 2025-12-25

Article Type : Research Paper

Abstract :Background: Holmium laser enucleation of the prostate (HOLEP) surgery has played a significant role in the treatment of benign prostatic hyperplasia. Since the definition of the classical three-lobe technique, many new techniques have been introduced. We aimed to compare the efficacy and safety of the en bloc and three-lobe techniques used in this surgery. Material and Methods: Medical data of 80 patients who underwent HoLEP surgery at a tertiary center were evaluated retrospectively. The patients were divided into 2 groups (en-bloc: 40, three-lobe: 40). All patients were evaluated for age, preoperative PSA, prostate size, maximum flow rate (Qmax), enucleation time, morcellation time, enucleated tissue weight, enucleation time efficacy (enucleated weight/enucleation time), morcellation time efficacy (enucleated weight/morcellation time), perioperative and postoperative complications and incontinence status. Results: There was no significant difference between the two groups in terms of age, PSA, and preoperative uroflowmetry results. 8 patients in the en-bloc group and 11 patients in the three-lobe group had a catheter preoperatively. Enucleation time was significantly shorter in the en-bloc group (p<0.001), while morcellation time was similar (p=0.706). Although the prostate volume was higher in the three-lobe group (p=0.013), no difference was observed in terms of enucleated tissue weight (p=0.261). Postoperative uroflowmetry results were similar in the two groups (p=0.628). Postoperative hematuria was observed in 2 patients in the en-bloc group and 4 patients in the three-lobe group. Prolonged incontinence developed in 6 patients in the en-bloc group and in 7 patients in the three-lobe group. No statistically significant difference was observed between the two groups in terms of complications. Conclusion: In reviewing the results of our study, we observed that both techniques yield comparably satisfactory outcomes and similar rates of late complications. However, the en-bloc technique demonstrates a significantly shorter enucleation time as well as a reduced overall operative duration.
Keywords : En-bloc, Three-lobe, HOLEP, Komplikasyon, Benign prostat hiperplazisi

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