Innovative Use of RADA16 Self-Assembling Peptide (PuraBond®) as a Hemostatic Agent in Holmium Laser Enucleation of the Prostate (HoLEP): A Safety and Feasibility Study

Hemostasis is a critical aspect of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH). While HoLEP offers superior outcomes compared to traditional techniques, effective intraoperative and postoperative bleeding control remains a challenge. This report evaluates the feasibility and safety of PuraBond® (3-D Matrix, Ltd., Chiyoda-ku, Tokyo), a self-assembling peptide (SAP) hemostatic agent, as an adjunct for hemostasis during HoLEP. A single case study was conducted in August 2024 on a 62-year-old male presenting with lower urinary tract symptoms (LUTSs) and a significantly enlarged prostate (152 cc). The patient underwent en-bloc low-power HoLEP under general anesthesia. Following enucleation and morcellation, initial hemostasis was achieved using bipolar diathermy, and PuraBond® was applied endoscopically to the prostatic fossa. Postoperatively, continuous bladder irrigation was initiated, and the patient was monitored for complications. The total operative time was 120 minutes, with 66 minutes for enucleation and 14 minutes for morcellation. A total of 147.7 g of prostatic tissue was enucleated. Hemostasis was successfully achieved with the combined use of diathermy and PuraBond®, resulting in clear irrigation effluent immediately postoperatively. The patient was discharged the same day without complications. The urinary catheter was removed nine days later, and the urine remained clear throughout the recovery period. At the 28-day follow-up, the patient reported significant symptomatic improvement with no hematuria or irritative urinary symptoms. There were no adverse events or readmissions within three months post-procedure. PuraBond® demonstrated effectiveness and safety as a hemostatic adjunct during HoLEP, providing stable hemostasis and facilitating an uneventful recovery. Its application represents a promising option for managing intraoperative and postoperative bleeding in urological procedures. Further research in larger patient cohorts is warranted to establish its efficacy and broader clinical applicability.