Influence of Early Apical Release on Outcomes in Endoscopic Enucleation of the Prostate: Results From a Multicenter Series of 4392 Patients

• DOI: 10.1016/j.urology.2024.03.003
• Publication Date: 2024-03-11T01:00:21Z
• Authors: Vineet Gauhar; Ee Jean Lim; Khi Yung Fong; Fernando Gómez Sa...; Moisés Rodríguez ...; Dmitry Enikeev; Mario Sofer; Azimdjon N. Tursu...; Dean Elterman; Mohammed Taif Ben...; Jeremy Yuen‑Chun ...; Abhay Mahajan; Tanuj Pal Bhatia; Sorokin Nikolai I...; Nariman Gadzhiev; Lie Kwok Ying; Biligere Sarvajit; Bhaskar Kumar Somani; Thomas R.W. Herrmann; Daniele Castellani
• Keywords: Male; Prostatectomy; Time Factors; Prostatic Hyperplasia; Endoscopy; Lasers, Solid-State; Middle Aged; Postoperative Complications; Treatment Outcome; Urinary Incontinence; Humans; Laser Therapy; Retrospective Studies; Aged

To evaluate outcomes after laser endoscopic enucleation of the prostate (EEP) stratified by whether early apical release (EAR) was performed or not.We retrospectively reviewed patients with clinical benign prostatic hyperplasia who underwent EEP with holmium or thulium fiber laser in 8 centers (January 2020-January 2022).previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, concomitant lower urinary tract surgery. One-to-one propensity score-matching was performed between patients with EAR vs no EAR, with covariates including age, prostate volume, diabetes mellitus, hypertension, preoperative indwelling catheter, IPSS, Qmax, enucleation, and laser types. Multivariable logistic regression analyses were performed to evaluate independent predictors of 30-day postoperative complications and urinary incontinence.EAR was performed in 2094 of 4392 included patients. The matched cohort consisted of 787 patients per arm. Total operation time was significantly longer in the EAR group (median 75 vs 67 minutes, P = .004). Early complications were higher in the EAR group (18.6% vs 12.5%, P = .001), while postoperative incontinence rates were similar (14.1% vs 13.1%, P = .61). Multivariable regression analysis showed that 3-lobe enucleation and operation time were significant predictors of postoperative complications; preoperative indwelling catheterization, higher prostate volume, and en-bloc enucleation were associated with higher odds of postoperative incontinence.retrospective nature.Performing EAR during EEP is associated with a greater incidence of early complications, which was mainly driven by higher rates of postoperative hematuria and perioperative transfusion. The risk of postoperative incontinence and its duration are not affected by EAR.