Application of En Bloc and Urethral Mucosal Flap Sparing Techniques Improve the Functional Outcomes in Holmium Laser Enucleation of Prostate: A Retrospective Case Control Study

The purpose of the study was to study the feasibility of holmium laser enucleation of prostate (HoLEP) with en bloc and urethral mucosal flap sparing technique in treating benign prostatic hyperplasia (BPH) patients and to evaluate the influence of this modified technique on urinary function. A cohort of 188 BPH patients underwent HoLEP from June 2017 to October 2019. Among them, 92 patients underwent conventional en bloc HoLEP and the other 96 patients underwent HoLEP with en bloc and urethral mucosal flap sparing techniques. The basic characteristics, the volume of the prostate, urodynamic data, and perioperative parameters were recorded for comparison. The outcome parameters include international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), post-voiding residual (PVR), quality of life score (QoL), and incidence of de novo stress urinary incontinence (SUI). The basic characteristics were equivalent in both groups. All HoLEP procedures were smoothly carried out. The perioperative complications were low and did not show a significant difference. The follow-up period was 12 months or longer. IPSS, Qmax, QoL, and PVR were improved postoperation in both groups. There was no statistical difference in the parameters between the two groups. When considering a postoperative SUI, the occurrence of short-term and long-term SUI in the modified HoLEP group was significantly less than those in the conventional HoLEP group (p < 0.05). In summary, HoLEP by using en bloc and urethral mucosal flap sparing technique is a safe and effective treatment for BPH patients, especially in preventing postoperative SUI.