Clinical Report: Evaluating the Use of a 21 Fr Internal Urethrotomy Sheath for HoLEP

Overview

This study evaluates the short-term outcomes of a modified low-caliber HoLEP technique using a 21 Fr internal urethrotomy sheath compared to standard HoLEP. The findings suggest that this approach may provide a viable alternative in resource-constrained environments.

Background

Benign prostatic hyperplasia (BPH) is a prevalent condition causing lower urinary tract symptoms (LUTS) in aging men, often necessitating surgical intervention when medical therapy fails. Holmium laser enucleation of the prostate (HoLEP) has emerged as a minimally invasive alternative to traditional methods, offering advantages such as reduced bleeding and shorter recovery times. However, the standard equipment for HoLEP can be costly and less accessible in resource-limited settings.

Data Highlights

No numerical data provided in the source material.

Key Findings

• The study included 47 patients undergoing modified low-caliber HoLEP (mLC-HoLEP) and 48 patients undergoing standard HoLEP.
• Patients were matched based on age, prostate volume, preoperative IPSS, and preoperative Qmax.
• The modified technique utilized a 21 Fr internal urethrotomy sheath and passive suprapubic bladder drainage.
• Urethral stricture rates following HoLEP range between 2% and 5% in the literature.
• Miniaturized instruments have been associated with lower rates of early transient urinary incontinence compared to standard HoLEP.

Clinical Implications

The modified low-caliber HoLEP technique may offer a practical solution for surgical management of BPH in settings with limited resources. Utilizing existing equipment can enhance accessibility and reduce costs associated with surgical interventions.

Conclusion

The findings indicate that mLC-HoLEP may serve as a safe and effective alternative to standard HoLEP, particularly in resource-constrained environments.

Related Resources & Content

1. Author(s)/Org, Source, Year -- Evaluating Instrument Size: A Comparison of 22 Fr Miniaturized and 26 Fr Standard Tools in Pulsed Thulium:YAG Laser Prostate Enucleation
2. Author(s)/Org, Source, Year -- The Impact of Pulse Modulation in En-Bloc HoLEP: Insights from a Propensity Score Matched Study
3. Author(s)/Org, Source, Year -- A Randomized Prospective Study on Ejaculatory Preservation in HoLEP Compared to Conventional HoLEP: Exploring Alternative Outcomes
4. Author(s)/Org, Source, Year -- Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part III: Procedural/Surgical Management | Journal of Urology
5. Comparison of Thulium Fiber Laser and Holmium Laser Enucleation Techniques for Prostate Treatment: Findings from a Randomized Non-Inferiority Study
6. Contemporary guidelines frame the role of endoscopic enucleation for LUTS/BPH
7. Recent comparative evidence informs perioperative expectations when selecting between TURP and enucleation approaches
8. Smaller scopes, bigger impact: retrospective outcomes of minimally invasive holmium enucleation of the prostate (MILEP) | BMC Urology | Springer Nature Link