En-bloc and non-en-bloc techniques for thulium laser enucleation of the prostate: a comparative study of surgical outcomes.

OBJECTIVES

To compare surgical outcomes between the en-bloc and non-en-bloc techniques of thulium laser enucleation of the prostate (ThuLEP) in patients with different prostate volumes (PV).

METHODS

We reviewed patients treated with ThuLEP for benign prostatic hyperplasia (BPH) at Peking University First Hospital from January 2020 to December 2022. Patients were categorized into en-bloc and non-en-bloc (the two-lobe and three-lobe techniques) according to enucleation techniques. Baseline characteristics, peri-operative and post-operative outcomes were evaluated. Subgroup analysis were conducted based on prostate volume (PV < 60 ml, 60 ≤ PV < 80 ml, and PV ≥ 80 ml). Propensity score matching (PSM) was used to reduce confounding.

RESULTS

A total of 540 patients were included with 196 patients undergoing en-bloc enucleation and 344 patients undergoing non-en-bloc enucleation. The baseline characteristics between the two groups were similar. The en-bloc technique demonstrated reduced operation time (median: 59.0 vs. 78.0 min, P < 0.001) and increased operation efficiency (median: 0.84 vs. 0.63 g/min, P < 0.001) compared to the non-en-bloc techniques, with similar post-operative complication rates (6.1% vs. 4.7%, P = 0.458). Sub-group analysis based on prostate volume revealed that the en-bloc technique resulted in decreased operation time and improved operation efficiency for patients with PV > 80 ml and between 60 and 80 ml. However, no significant difference was observed between en-bloc and non-en-bloc techniques for patients with PV ≤ 60 ml.

CONCLUSIONS

In patients with PV > 60 ml, the en-bloc technique is advantageous in operation time and efficiency compared to non-en-bloc techniques. For those with PV < 60 ml, the en-bloc and non-en-bloc techniques exhibit similar operation time and efficiency.