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

Summary 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 (20 W and 37.5 W). Methods One hundred and sixty patients underwent a HoLEP procedure with a 50 Hz and 2 J (100 W) setting. During enuleation and hemostasis, two different low-power settings were applied (20 W vs. 37.5 W). 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 50 Hz and 2 J (100 W). Results The mean enucleation efficiency (0.78 vs. 1.2 g/min-p:001) was significantly higher by utilizing 37.5 W 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. 0.6 g/dl-–P:0.019) were significantly lower in group 2. Conclusions HoLEP can be performed efficiently with 100 W–37.5 W settings. Enucleation and hemostasis can be performed successfully with 37.5 W, while the use of 100 W during bladder neck dissection shortens the duration of the procedure. Level of evidence 3.