REVIEW   Free access

Minerva Urologica e Nefrologica 2017 October;69(5):446-58

DOI: 10.23736/S0393-2249.17.02834-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation

Richard NASPRO ¹ ✉, Fernando GOMEZ SANCHA ², Michele MANICA ¹, Agostino MENEGHINI ³, Sascha AHYAI ⁴, Tevita AHO ⁵, Cristian FIORI ⁶, Ivano VAVASSORI ⁷, Luigi F. DA POZZO ¹, Vito PANSADORO ⁸, Francesco MONTORSI ⁹, Thomas R. HERRMANN ¹⁰

¹ Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy; ² Department of Urology and Robotic Surgery, ICUA, Clínica CEMTRO, Madrid, Spain; ³ Department of Urology, Azienda Ulss 19, Adria, Rovigo, Italy; ⁴ Department of Urology, University Medical Center Göttingen, Göttingen, Germany; ⁵ Department of Urology, Addenbrooke’s Hospital, Hills Road, Cambridge, UK; ⁶ Department of Urology, A.O.U. San Luigi Gonzaga, Università degli Studi di Torino, Orbassano, Turin, Italy; ⁷ Department of Urology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Bergamo, Italy; ⁸ Department of Urology, Fondazione Vincenzo Pansadoro, Rome, Italy; ⁹ Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; ¹⁰ Department of Urology and Urological Oncology, Division of Endourology and Laparoscopy, Hannover Medical School, Hannover, Germany

BACKGROUND: Open prostatectomy (OP) and transurethral resection of the prostate (TURP) have traditionally been the most common surgical approaches for the treatment of benign prostatic hyperplasia causing bladder outlet obstruction and have certainly passed the test of time. In time, many endoscopic surgical procedures have been described as an alternative mini-invasive treatment. Holmium laser enucleation (HoLEP) guaranteed functional outcomes similar to OP and TURP with lower perioperative complication rates for any prostate size. With the development of different kinds of lasers (such as thulium, “green light” and diode) and bipolar energy, the feasibility of endoscopic enucleation using these energies has been explored.
EVIDENCE ACQUISITION: In this paper, recent techniques to perform true prostate enucleation have been reviewed through a search of PubMed and Web of Science, including articles published in the last 20 years in clinical journals. The review is based on a peer-review process of the authors after a structured data search. Search terms included “Thulium prostate enucleation, THULEP, TmLEP/Tm Yag enucleation” OR “Greenlight enucleation/prostate enucleation/vapo-enucleation/KTP prostate enucleation, PVP prostate enucleation, GreenLep/” OR “bipolar prostate enucleation” OR “HoLEP, Holmium prostate enucleation” OR “monopolar prostate enucleation” OR “Diode prostate enucleation” OR “DiLEP” OR “Eraser prostate enucleation” OR “ELEP”.
EVIDENCE SYNTHESIS: Following the example of HoLEP, many techniques have been described in the literature using a variety of energy sources and instruments either in a pure enucleative or a hybrid (mixed) fashion. However, the levels of evidence are too low and follow-up still too short to offer solid recommendations.
CONCLUSIONS: HoLEP has become the conceptual and practical paradigm for the wide spread of enucleation thanks to the evidence provided by the literature and excellent outcomes. Higher level of evidence is required to assess efficacy of alternative enucleative techniques.

KEY WORDS: Prostate - Lasers - Surgery