Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as a new gold standard for treatment of benign prostatic hyperplasia (BPH); however, its steep learning curve hinders generalization of this technique. Therefore, there is a need for a benchtop HoLEP simulator to reduce this learning curve and provide training. We have developed a non-biohazardous HoLEP simulator using modern education theory and validated it in a multicenter study. Materials and Methods: Six experts established key components for a HoLEP simulator via a Delphi consensus over three rounds including 250 questions. Following consensus, a digital design was created and approved by experts, then used to fabricate a physical prototype using 3D printing and hydrogel molding. After a process of iterative prototype testing, experts completed a survey assessing the simulator with a five-point Likert scale for final approval. The approved model was validated with 56 expert and novice participants at seven institutions using subjective and objective performance metrics. Results: Consensus was reached on 85/250 questions and experts found the physical model to adequately replicate 82.5% of required features. Objective metrics were statistically significant (p<0.0001) when comparing experts and novices for procedure time (37.4 +/- 8.2 vs 16.7+/- 6.8 min), adenoma weight (79.6+/- 20.4 vs 36.2 +/- 9.9 gm), and complications (6 vs 22) respectively. Conclusion: We have successfully completed a multi-center study to develop and validate a non-biohazardous benchtop simulator for HoLEP through modern education theory. A training curriculum including this simulator is currently under development.

Background & Objectives: Patients with bladder outlet obstruction (BOO) due to massive prostate enlargement have several surgical treatment options, such as robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP). Postoperative outcomes may differ between those undergoing RASP and HoLEP. RASP has been associated with a lower incidence of transient stress urinary incontinence (SUI), while HoLEP allows for shorter catheterization times. Here, we report on our experience with both surgical modalities. Methods: Data were collected from prospectively maintained databases for 37 RASP patients and 181 HoLEP patients treated from July 2021 to November 2023. To control for selection bias, propensity score matching (PSM) was utilized based on age and prostate size. We compared patients’ preoperative, perioperative, and postoperative outcomes both before and after applying PSM. Results: Before the PSM, the median prostate size was significantly lower in the HoLEP group (p < 0.001). The HoLEP group also had significantly shorter operative times (p ≤ 0.001) and lower weights of resected adenoma (p ≤ 0.001). After the PSM of 31 RASP and 31 HoLEP patients, all baseline patient characteristics were comparable. No significant differences were observed in operation time (p = 0.140) or in the weight of resected adenoma (p = 0.394) between the modalities. The median (IQR) length of catheterization was significantly shorter in the HoLEP group (1 [1–4] days) compared to the RASP group (7 [7–8] days), in both pre- and post-matching analyses (p ≤ 0.001 for both), reflecting the standard of practice. In contrast, in both pre- and post-PSM analyses, the average hospital stay was significantly shorter in the RASP cohort, as same-day discharge is standard in our center, whereas the HoLEP cohort required overnight stays due to routine continuous bladder irrigation before discharge (p < 0.001 for all). Notably, the SUI rates and American Urological Association (AUA) symptom scores were comparable at 3 months within both matched and unmatched cohorts (pre-PSM: p = 0.668, p = 0.083; post-PSM: p = 1, p = 0.152, respectively). Conclusions: Our comparative analysis indicates that both RASP and HoLEP yield similar outcomes, including SUI rates, at 3 months. While HoLEP provided shorter durations of postoperative catheterization, RASP offered shorter hospital stays.

Introduction: Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent, endoscopic management option for benign prostatic hyperplasia (BPH). HoLEP offers a distinct advantage for patients who are at high-risk ... | Find, read and cite all the research you need on Tech Science Press

Water vapor thermal therapy is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses steam to ablate prostatic tissue to relieve lower urinary tract symptoms associated with BPH. It is an option for 30 to 80 g prostates in well-selected patients, and may avoid sexual side effects seen in other more invasive BPH treatments. It is a simple procedure with a short learning curve that can be performed in-office under local and oral anesthesia. Water vapor therapy should be offered to ideal candidates along with information regarding its risks, benefits, and outcomes.