A Novel Technique of Laser Enucleation of Prostate: Early Release Top-Down Laser Enucleation of Prostate

Benign prostatic hyperplasia (BPH) is a common condition in aging men that often necessitates surgical intervention when symptoms become severe. Holmium Laser Enucleation of the Prostate (HoLEP) has proven safety and efficacy, yet temporary stress incontinence remains a postoperative challenge. This study evaluates the efficacy of the early release top-down HoLEP technique in minimizing stress incontinence while preserving optimal enucleation outcomes. In a prospective cohort of 73 male patients diagnosed with BPH, procedures were conducted using a 26Fr scope and thulium fiber laser between July 2023 and August 2024. Postoperative evaluations were performed at 2 weeks, 1 month, and 3 months, assessing temporary stress incontinence (via cough test/pad usage), uroflowmetry (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and prostate-specific antigen (PSA) levels. The primary endpoint was the reduction in temporary stress incontinence, with secondary outcomes including improvements in Qmax, PVR, IPSS, and PSA. Preoperative mean patient age was 66.8 years, mean prostate volume was 80.75 cm³, and mean Qmax was 8.6 mL/sec. Postoperative stress incontinence rates were reduced to 4.1% at 2 weeks, 1.4% at 1 month, and 0% at 3 months. Improvements in Qmax, PVR, IPSS, and decline of PSA are demonstrated. The early release top-down HoLEP technique demonstrates promise in reducing temporary stress incontinence while achieving favorable enucleation outcomes, warranting further controlled trials for confirmation.