{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:40:33Z","timestamp":1780735233991,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJUI Compass"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the safety and feasibility of \u201cen\u2010bloc\u201d Holmium Laser Enucleation of the Prostate (HoLEP) with trainee involvement in patients with prostates larger than 200\u2009cc.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>A retrospective analysis was conducted on patients undergoing HoLEP using the \u201cen\u2010bloc\u201d technique for prostate sizes &gt; 200\u2009cc between July\u20102017 and December\u20102023 at an academic teaching hospital. Perioperative data was collected, including patient demographics, clinical parameters, operative details and functional outcomes. Patients who continued to experience incontinence at 1\u2009year were further followed up at 2\u2009years to update their continence status. Sub\u2010group analysis was performed to compare outcomes between patients with preoperative prostate size of 200\u2013300\u2009cc and &gt; 300\u2009cc.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis included 89 patients with a mean age of 73.12 \u00b1 8.10\u00a0years. Preoperative prostate weight ranged from 200 to 401\u2009cc with a median of 245\u2009cc, and median PSA was 7.71\u2009ng\/ml. Median operative time was 218.5\u00a0minutes, and median enucleated prostate volume was 164.2\u00a0cc. Median postoperative PSA was 0.4 [0.21\u20130.78] ng\/ml. At 1\u2010year follow\u2010up, mean IPSS was 1 \u00b1 2.4, Qmax was 27.03 \u00b1 11.57\u2009ml\/s and PVR was 21.6 \u00b1 28.6\u00a0ml. Postoperative complications included blood transfusion (5.6%), acute renal injury (4.5%), urinary tract infection (2.2%), postoperative urinary retention (2.2%) and urethral stricture (5%). Although transient urinary incontinence was noted in 41.6% at 1\u20133\u2010months, complete continence was achieved in 83.3% and 96.3% at 1 and 2\u00a0years postoperatively, respectively. Subgroup analysis showed significant differences in operative time and enucleated weight between prostates 200\u2013300\u2009cc and &gt; 300\u2009cc, but no significant differences in postoperative IPSS, PVR or Qmax at 3\u2010months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>\u201cEn\u2010bloc\u201d HoLEP is a feasible and safe procedure for prostates larger than 200\u2009cc, demonstrating favourable perioperative and functional outcomes despite the extended operative times and involvement of trainees.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bco2.469","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T02:00:30Z","timestamp":1734746430000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Safety and feasibility of En\u2010bloc holmium laser enucleation for very large prostates (&gt; 200\u2009cc) with trainee involvement"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-1624","authenticated-orcid":false,"given":"Feres C.","family":"Maluf","sequence":"first","affiliation":[{"name":"University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6131-4837","authenticated-orcid":false,"given":"Ansh","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archan","family":"Khandekar","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana M.","family":"Lopategui","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6495-1054","authenticated-orcid":false,"given":"Joao G.","family":"Porto","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan R.","family":"Chen","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean C.","family":"Daher","sequence":"additional","affiliation":[{"name":"Miller School of Medicine Desai Sethi Urology Institute, University of Miami  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamadhusni","family":"Zarli","sequence":"additional","affiliation":[{"name":"Dr. Kiran C. 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