"En bloc" enucleation with early apical release of the urinary sphincter compared to prostate enucleation with standard holmium laser technique in the treatment of Benign Prostatic Hyperplasia

Abstract

Introduction: Benign prostatic hyperplasia is the most common disease among older men. Traditional HoLEP surgical methods include 3-lobe, 2-lobe, and en bloc enucleation techniques. Objective: Compare the effectiveness of "en bloc" enucleation with early apical release of the urinary sphincter with prostate enucleation with standard holmium laser technique in the treatment of Benign Prostatic Hyperplasia. Methodology: A theoretical review was carried out, based on a significant question that exposes the reason for the theoretical research and the answer through the search for scientific information, through the PICOT strategy; through DeCS/MeSH terms in health databases such as: Cochrane Library, Pubmed, and ScienceDirect. 364 articles were identified and only 5 were included. The articles found were evaluated with quality standards using PRISMA, CONSORT and STROBE criteria. Results: The authors consulted suggest that both “en bloc” enucleation with early apical release of the urinary sphincter and prostate enucleation with the standard Holmium laser technique are effective techniques for the treatment of BPH. En bloc enucleation with early apical release of the sphincter with Holmium laser provides advantages in terms of complications, general operative time, enucleation time and postoperative incontinence rate. Conclusions: En bloc enucleation with early apical sphincter release could offer additional benefits in terms of operative time and complications. Despite this, more multicenter studies and randomized clinical trials are needed to validate these results and establish clear guidelines for the choice of surgical technique in the treatment of benign prostatic hyperplasia