Presented by: Tarek Taha MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Introduction

Minimal invasiveness improves outcome in many surgical fields including urology. We aimed to assess intraoperative performance and clinical outcome of miniaturized holmium laser enucleation of prostate (MiLEP) by means of a novel 22FR laser endoscope with a same-size adapted morcescope.

Materials

We ran a propensity score-matched analysis on all consecutive laser enucleations of prostate performed in our institution between 9/2022 and 2/2023. It resulted in two matched groups of men who underwent MiLEP 22 FR and those who underwent holmium laser enucleation of prostate (HoLEP 26 Fr). Their demographics, presentations, indications for surgery, intraoperative course, and outcomes underwent statistical analysis.

Results

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Eighty men were suitable for study entry (MiLEP 22 FR [n = 40] and HoLEP 26 Fr [n = 40]). MiLEP was associated with significantly less intraoperative irrigation (20.5 L vs 15 L, p = 0.002^E-3), less decrease in body core temperature (0.6^oC vs 0.1^oC, p = 0.003^E-5), and less need for meatal dilation (25% vs 78%, p = 0.01^E-3). These parameters were identified as being independent in the multivariate analysis. There was a trend towards less and a shorter period of postoperative stress incontinence (SI) for the MiLEP group compared to the HoLEP group: 15% and 42% (p = 0.01) at 1 month, 8% and 14% (p = 0.07) at 2 months, and 0 and 0.3% (p = 1) at 3 months, respectively. There were no differences in prostatic enucleation effectiveness, operative time, hospital stay, complications, and improvement in the international prostate symptom score and quality of life score.

Conclusion

MiLEP is feasible and provides better maintenance of body core temperature, reduction in amount of fluid irrigation, and decrease in need for meatal dilation without affecting effectiveness in comparison to HoLEP. MiLEP may reduce early postoperative stress incontinence, thereby shortening the recovery period.

Funding

None

Co-Authors

Savin Ziv, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Karin Lifshitz, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Yotam Verdgoron, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Tomer Mendelson, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Yuval Bar-Yosef, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Ofer Yossepowitch, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel

Mario Sofer, MD
Sourasky Medical Center (Ichilov), Tel-Aviv, Israel