Associate Professor Urology and Nephrology Center, Mansoura University
Introduction: Holmium laser enucleation of the prostate (HoLEP) is becoming a new standard technique for treatment of BPH. However, transient early postoperative urine incontinence is a frustrating concern both for the surgeon and patient. Furthermore, steep learning curve hinders wide adoption of the procedure. We aimed at developing of a new technique for HoLEP, that improves early continence and provides structural approach to abridge learning difficulties. In this trial the new veil sparring HoLEP will be compared to standard popularly utilized Elhilali technique (1). ClinicalTrials.gov ID; NCT03494049 Methods: Veil sparring HOLEP was performed in stepwise approach abbreviated for sake of learning as (IT PAS ABCD), detailed in the accompanying video. Between January 2017 and June 2020, 180 procedures were randomly allocated to Standard HoLEP (91) and Veil sparring HOLEP (89). All preoperative parameters were comparable between the 2 groups. Patients were followed up at 1, 4 and 12 months postoperatively. Routine assessment was done using IPSS, Qol questionnaires with uroflowmetry and PVR. One-hour pad test was performed at each visit to objectively report any urine leak. Results: All perioperative outcome measures were comparable between the 2 groups. Mean enucleation efficiency was 1.62gm +0.4 and 1.58 + 0.5 gm/min, P=0.6 following Standard HoLEP and Veil sparring HOLEP respectively. The mean postoperative catheter time and hospital stay were 1.3 + 0.2 vs. 1.2 + 0.3 days, P=0.9 and 1.5 + 0.3 vs. 1.4 + 0.2 days, P 0.3 following Standard HoLEP and Veil sparring HOLEP respectively. Significant comparable improvement in all urinary functional outcome measures (IPSS, Qol, Q.max and PVR) was reported as all follow up visits from baseline (P> 0.05). No Grade III or more Clavien-Dindo complications were reported. Table 1 summarizes postoperative continence as depicted by one hour pad test at different follow up favouring Veil sparring HOLEP at 1 and 4 months postoperatively Conclusions: Sparring a mucosal veil around sphincter ring with early apical release is associated with better short term continence outcomes. The ABCD approach provides reproducible way for HOLEP learning. Reference Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 2010 Mar;105(5):584-5. SOURCE OF Funding: no
