Top-down vs. Traditional Anatomical Endoscopic Enucleation of the Prostate (AEEP): Does the direction of enucleation matter? - presented by Dr. Hazem Elmansy MD, MSc, FRCSC and Dr Riccardo Lombardo

Top-down vs. Traditional Anatomical Endoscopic Enucleation of the Prostate (AEEP): Does the direction of enucleation matter?

Dr. Hazem Elmansy MD, MSc, FRCSC

Dr. Hazem Elmansy MD, MSc, FRCSC
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Top-down vs. Traditional Anatomical Endoscopic Enucleation of the Prostate (AEEP): Does the direction of enucleation matter?
Dr. Hazem Elmansy MD, MSc, FRCSC
Hazem Elmansy
Northern Ontario School of Medicine (NOSM), Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario Canada
Chaired by Riccardo Lombardo

Associated Prostate Cancer and Prostatic Diseases article

H. Elmansy et al. (2023) Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer and Prostatic Diseases
Article of record

BACKGROUND: The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g.

METHODS: One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months.

RESULTS: There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60min, which was not significantly longer than that of top-down HoLEP (52min) (p=0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p =0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months.

CONCLUSIONS: The HoLEP procedure significantly improves patients’ urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

References
  • 1.
    H. Elmansy et al. (2023) Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer and Prostatic Diseases
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H. Elmansy (2024, February 19), Top-down vs. Traditional Anatomical Endoscopic Enucleation of the Prostate (AEEP): Does the direction of enucleation matter?
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Video length 53:21
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