ArticleRevista da Associacao Medica Brasileira (1992)2026
Comparison of three-lobe and en-bloc techniques during the holmium laser enucleation of the prostate learning curve: a prospective, multicenter, cohort study.
Article in Revista da Associacao Medica Brasileira (1992), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe aim of this study was to compare the safety and effectiveness of the three-lobe and en-bloc techniques during the learning curve of holmium laser enucleation of the prostate.
methodsWe conducted a prospective, parallel-group, multicenter study that included patients who underwent holmium laser enucleation of the prostate between February and December 2024 at two tertiary urology departments. Patients with prostate volumes ≥80 cm3 scheduled for holmium laser enucleation of the prostate were alternately assigned (1:1) to either the three-lobe or en-bloc technique. Exclusion criteria included use of anticoagulants, prostate biopsy within the previous month, diagnosis of prostate cancer, or a history of pelvic surgery or radiotherapy associated with overactive bladder symptoms. The study evaluated the performance of a single surgeon at each center using either the three-lobe or en-bloc technique during their holmium laser enucleation of the prostate learning curve. Primary outcomes were enucleation time/efficiency and complications. Secondary outcomes included postoperative incontinence and functional outcomes.
resultsA total of 116 patients were enrolled in the study, with 60 in the three-lobe group and 56 in the en-bloc group. Patients in the en-bloc group were older than those in the three-lobe group (69.4 vs. 64.9 years, p=0.001). Body mass index and performance scores were comparable between groups. The mean prostate volume was 83.5 cm3 in the three-lobe group and 81.3 cm3 in the en-bloc group (p=0.732). No significant differences were observed in prostate volume or Prostate-Specific Antigen density. Short-term complication rates and postoperative urinary incontinence were similar between techniques. Operative and enucleation times were significantly shorter in the en-bloc group compared to the three-lobe group (86.1 vs. 107.4 min, p=0.042; 56.7 vs. 72.9 min, p=0.001, respectively). However, enucleation and morcellation efficiencies did not differ significantly. Other intraoperative parameters, as well as postoperative functional outcomes and uroflowmetry measurements, were comparable between the groups.
conclusionThe en-bloc technique demonstrated comparable safety and functional outcomes to the three-lobe technique but offered significantly shorter operative and enucleation times during the holmium laser enucleation of the prostate learning curve.
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