The low power effect on holmium laser enucleation of prostate (HoLEP); A comparison between 20W and 37,5W energy regarding apical enucleation efficacy and patient safety.

Introduction: The Holmium laser has proven to be an invaluable tool for endoscopic prostate enucleation. The proper energy selection, during the different steps of the procedure, has always been a matter of debate. In this work we compare the effectiveness of the Holmium laser, using two different low-power energy settings, during enucleation and hemostasis (20W and 37.5W).

Methods: One hundred and sixty patients underwent a HoLEP procedure with a 50Hz and 2J (100W) setting. During enuleation and hemostasis, two different low-power settings were applied (20W vs. 37.5W). In both groups, only the prostatic tissue in the bladder neck and enucleated tissue far away from the apex, were cut with a setting of 50Hz and 2J (100W).

Results: The mean enucleation efficiency (0.78 vs. 1.2g/min-p:001) was significantly higher by utilizing 37.5W energy (group 2). Additionally, the mean enucleation rate (0.64 vs. 0.88%-P:0.001) and laser efficiency (2.07 vs. 2.12 joule/g-P:0.003) were significantly higher in group 2. The enucleation time was significantly shorter (54 vs. 75.5 mins-P:0.002), while the mean catheter removal time (27 vs. 42 hrs-P:0.008) and Hb decrease (0.5 vs. 0.6g/dl--P:0.019) were significantly lower in group 2.

Conclusions: HoLEP can be performed efficiently with 100 W-37.5W settings. Enucleation and hemostasis can be performed successfully with 37.5W, while the use of 100W during bladder neck dissection shortens the duration of the procedure.

Level Of Evidence: 3.