Holmium Laser Enucleation of the Prostate Versus Bipolar Transurethral Enucleation of the Prostate in Management of Benign Prostatic Hyperplasia

Abstract

BPH is the most common cause of LUTS in elderly men. Endoscopic enucleation of the prostate is an anatomical enucleation that mimics the surgeon’s index finger that is developed to overcome the morbidity of TURP in large prostatic adenoma The first enucleation was done by Hiraoko in 1983 using a monopolar resection. Gilling in 1998, he developed the first HoLEP technique. In 2004, Neill demonstrated the first BPEP. In the late 2000s, all other laser-based enucleation techniques started to develop. The Ho: YAG laser is a pulsed laser of a wavelength of 2140 nm. The laser energy is mainly absorbed by water from the irrigation fluid and in the cells and extracellular space in the tissue which leads to a very short penetration depth into the (prostatic) tissue (~0.4 mm). Refinement of the HoLEP technique was done by Bazeem et al, in 2009 with blunt dissection and early separation of the adenoma proximal to the sphincter. Enucleation is a size-independent surgical technique regardless of the energy source being used and depends mainly on the surgeon’s skills.