HoLEP techniques - lessons learned

Introduction: Holmium laser enucleation of the prostate (HoLEP) with mechanical tissue morcellation is one of the most effective surgical modalitiesfar the treatment of symptomatic BPH. HoLEP has many advantages over the historical gold standards open prostatectomy (OP) and transurethral resection of the prostate (TURP). HoLEP is an AUA guideline endorsed surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), independent of prostate size. Materials and methods: We provide a detailed presentation of our experience in performing HoLEP in a teaching university hospital, with an emphasis on the surgical technique and its evolution. Results: HoLEP is an efficient and durable procedure, although it is very equipment sensitive and has a relatively long learning curve. HoLEP can be performed by several surgical approaches that can be used according to the specific anatomy of the patient. Advances in laser technology, endoscopic morcellators, and surgical technique has improved the HoLEP procedure in efficiency, hemostasis, and safety. Conclusions: The HoLEP procedure, first introduced in 1998, has undergone significant changes including advancements in laser technology, endoscopic morcellation devices, and modifications to the surgical technique. These advancements have made HoLEP a more effective, more efficient, easier to perform, and easier to learn technique for the surgical management of BPH. The modified 2-lobe and the en-bloc techniques are a natural progression from the classic 3-lobe technique.