title: En-Bloc Technique With Anteroposterior Dissection Holmium Laser Enucleation of the Prostate Allows a Short Operative Time and Acceptable Outcomes.
abstract: OBJECTIVE
  To simplify anteroposterior dissection holmium laser enucleation of the prostate by combining it with a novel en-bloc enucleation technique that omits median lobe enucleation and removes the adenoma en-bloc in benign prostatic hyperplasia patients.
  
  
  METHODS
  Between September 2013 and May 2014, 65 patients with benign prostatic hyperplasia underwent holmium laser enucleation of the prostate with the en-bloc technique we developed at our institution. Twenty-six patients who underwent surgery performed by the same experienced surgeon were included in our study. We evaluated the surgical parameters, including total operative time, enucleation time, morcellation time, and hemoglobin loss. Peak flow rate and postvoid residual urine volume were assessed 3 months postoperatively, and urinary incontinence was assessed 1 day after catheter removal and at 1 and 3 months postoperatively in all patients.
  
  
  RESULTS
  Mean total operating time and mean enucleation time were 56.4 and 26.5 minutes, respectively. Peak flow rate and postvoid residual urine volume significantly improved. The incidence of postoperative incontinence at 3 months was 3%.
  
  
  CONCLUSIONS
  Our en-bloc enucleation method required a short operating time and may address concerns regarding the complexity of the enucleation procedure. We believe the incidence of postoperative incontinence can be further reduced with additional refinements of this procedure.
authors.affiliation: Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan. Electronic address: minagawa.shingo@ims.gr.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Minagawa
authors.affiliation: Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Okada
authors.affiliation: Department of Urology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Department of Urology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Toyofuku
authors.affiliation: Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Morikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D016896:Treatment Outcome