Presented by: Mouneeb Choudry MD
Mayo Clinic Arizona

Introduction

Early apical release has been reported to improve mucosal preservation of the external sphincter mucosa of the urethra. However, clinical implications remain relatively understudied. This is a single center, retrospective review to compare the standard and early apical release techniques for Holmium Laser Enucleation of the Prostate (HoLEP).  Our aim was to investigate the difference in postoperative incontinence and quality of life for BPH patients treated with HoLEP using the standard vs apical release technique.

Materials

A retrospective review was performed to identify patients who underwent HoLEP from December 2021 to July 2022. A total of 114 patients underwent HoLEP, 60 patients using an early apical technique and 54 patients using a standard technique. Preoperative assessments included American Urological Association symptom score (AUASS), American Urological Association QoL score, serum prostate-specific antigen (PSA), and prostate volume. Perioperative parameters included total operating time, total laser time, total morcellation time, and duration of postoperative catheterization. Postoperative evaluations were obtained at 6 weeks and 3 months. These evaluations included AUASS, AUASS QoL, and number of pads used per day. Wilcoxon and chi-squared tests were used to evaluate differences between the two surgical groups in terms of continuous and categorical variables, respectively. A logistic regression was used to evaluate the usage of pads post-operatively, when controlling for age and prostate size, between the two surgical groups. 

Results

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Pre-operatively, there was no significant difference between the two groups in regard to AUASS, with a median overall score of 22.00 [IQR, 16.25-26.75]. Post-operatively, at 6 week follow up, the apical release cohort reported greater improvement in AUASS (p-value: 0.034) and Quality of Life (p-value: 0.001) relative to the standard technique group.  The apical release group also reported significantly lower incontinence rates at 6 weeks post-operatively (p-value: 0.001), with 96.7% of men reporting the use of 1 pad or less per day compared to 42.6% in the standard technique group. Likewise, when controlling for prostate size and age, the apical release cohort was less likely to require 1 pad or more post-operatively at 6 weeks when compared to the standard HoLEP cohort, with an OR 0.59 (95% CI 0.51-0.67, p= .001).

Conclusion

Compared to standard technique, early apical release HoLEP technique promotes improved return of continence and quality of life within 3 months of surgery.

Funding

None

Lead Authors

Daniel Heidenberg, MD
Mayo Clinic Arizona

Nicholas Parker, MD
Mayo Clinic Arizona

Jeffery Stagg, MD
Mayo Clinic Arizona

Kevin Wymer, MD
Mayo Clinic Arizona

Scott Cheney, MD
Mayo Clinic Arizona

Mitchell Humphreys, MD
Mayo Clinic Arizona