Miniaturized laser enucleation of the prostate (MiLEP) is feasible and safe: 12-month follow-up, real-life, prospective multicenter study.

BACKGROUND

Holmium laser enucleation of the prostate (HoLEP) is considered one of the option for the treatment of men with bothersome lower urinary tract symptoms (LUTS) related to Benign Prostatic Obstruction (BPO). HoLEP is performed with 26Ch instruments, which can cause urethral trauma, strictures, transient incontinence. Recent miniaturized 22Ch tools (MiLEP) aim to reduce morbidity without compromising efficacy.

METHODS

This is a prospective multicenter study on men underwent MiLEP. Preoperative assessment included IPSS, uroflowmetry, PSA, prostate volume and urinary continence. The MiLEP were performed en-bloc with early apical release. Follow-up assessed subjective and objective outcomes together with complications and patient satisfaction. Clinical success was defined as Trifecta.

RESULTS

Sixty-five men were enrolled. No major intraoperative complications occurred; median catheterization and hospital stay were 2 and 2 days, respectively. Overall complication rate was 18.4%, mostly Clavien-Dindo grade I-II. Late complications were urethral stricture in 4.6% and persistent stress incontinence in 1.5%. At 12 months, mean IPSS, IPSS QoL, Qmax, PSA significantly improved (all p < 0.001). Overall satisfaction was very high (96.8%). Trifecta was achieved in 61.5% of cases. Logistic regression identified lower pre operative Qmax as the only predictor of Trifecta achievement.

CONCLUSIONS

MiLEP appears feasible and safe in this preliminary series, with perioperative and functional outcomes consistent with enucleation-like goals. Significant improvements in symptom scores, flow rate and PSA were sustained at 12 months with low morbidity and high continence preservation. Larger appropriate trials and longer follow up are needed to confirm our data.