{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:40:37Z","timestamp":1780735237796,"version":"3.54.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T00:00:00Z","timestamp":1714953600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T00:00:00Z","timestamp":1714953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Bergen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (&gt;\u200980\u00a0cc) and very large prostates (&gt;\u2009200\u00a0cc). The secondary aim was to determine the influence of energy and instruments used.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data of patients with\u2009&gt;\u200980\u00a0cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), enucleation time was longer in the non en-bloc group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) but morcellation times were similar (<jats:italic>p<\/jats:italic>\u2009=\u20090.054). Overall, 30\u00a0day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; <jats:italic>p<\/jats:italic>\u2009=\u20090.032). Rate of late complications (&gt;\u200930\u00a0days) was similar (2.3% vs. 2.5%; <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-024-04959-6","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T18:02:56Z","timestamp":1715018576000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-1283","authenticated-orcid":false,"given":"Patrick","family":"Julieb\u00f8-Jones","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Gauhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Castellani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khi Yung","family":"Fong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Sofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Zawadzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nariman","family":"Gadzhiev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo Maria","family":"Pirola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhay D.","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj Nandkishore","family":"Maheshwari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vigen","family":"Malkhasyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarvajit","family":"Biligere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet \u0130lker","family":"G\u00f6kce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigo","family":"Cormio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitry","family":"Enikeev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"G\u00f3mez Sancha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R. W.","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar K.","family":"Somani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,6]]},"reference":[{"key":"4959_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.04.008","author":"S Gravas","year":"2023","unstructured":"Gravas S, Gacci M, Gratzke C, Herrmann TR, Karavitakis M, Kyriazis I et al (2023) Summary paper on the 2023 European Association of Urology Guidelines on the management of non-neurogenic male lower urinary tract symptoms. Eur Urol. https:\/\/doi.org\/10.1016\/j.eururo.2023.04.008","journal-title":"Eur Urol"},{"key":"4959_CR2","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000003698","author":"JS Sandhu","year":"2023","unstructured":"Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT et al (2023) Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline amendment 2023. J Urol. https:\/\/doi.org\/10.1097\/JU.0000000000003698","journal-title":"J Urol"},{"issue":"1","key":"4959_CR3","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.aju.2015.10.001","volume":"14","author":"P Jones","year":"2016","unstructured":"Jones P, Alzweri L, Rai BP, Somani BK, Bates C, Aboumarzouk OM (2016) Holmium laser enucleation versus simple prostatectomy for treating large prostates: results of a systematic review and meta-analysis. Arab J Urol 14(1):50\u201358","journal-title":"Arab J Urol"},{"issue":"6","key":"4959_CR4","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1272\/jnms1923.50.896","volume":"50","author":"Y Hiraoka","year":"1983","unstructured":"Hiraoka Y (1983) A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia. Nihon Ika Daigaku Zasshi 50(6):896\u2013898","journal-title":"Nihon Ika Daigaku Zasshi"},{"issue":"7","key":"4959_CR5","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.1007\/s00345-021-03705-6","volume":"39","author":"M Pallauf","year":"2021","unstructured":"Pallauf M, Kunit T, Ramesmayer C, Deininger S, Herrmann TRW, Lusuardi L (2021) Endoscopic enucleation of the prostate (EEP). The same but different\u2014a systematic review. World J Urol 39(7):2383\u20132396","journal-title":"World J Urol"},{"issue":"3","key":"4959_CR6","doi-asserted-by":"publisher","first-page":"292","DOI":"10.23736\/S0393-2249.20.03706-6","volume":"72","author":"A Tuccio","year":"2020","unstructured":"Tuccio A, Sessa F, Campi R, Grosso AA, Viola L, Muto G et al (2020) En-bloc endoscopic enucleation of the prostate: a systematic review of the literature. Minerva Urol Nefrol 72(3):292\u2013312","journal-title":"Minerva Urol Nefrol"},{"issue":"8","key":"4959_CR7","doi-asserted-by":"publisher","DOI":"10.1111\/and.13587","volume":"52","author":"TRW Herrmann","year":"2020","unstructured":"Herrmann TRW, Wolters M (2020) Transurethral anatomical enucleation of the prostate with Tm: YAG support (ThuLEP): evolution and variations of the technique. The inventors\u2019 perspective. Andrologia 52(8):e13587","journal-title":"Andrologia"},{"issue":"Suppl 1","key":"4959_CR8","first-page":"53","volume":"22","author":"LB Lerner","year":"2015","unstructured":"Lerner LB, Rajender A (2015) Laser prostate enucleation techniques. Can J Urol 22(Suppl 1):53\u201359","journal-title":"Can J Urol"},{"issue":"11","key":"4959_CR9","doi-asserted-by":"publisher","first-page":"2451","DOI":"10.1007\/s00345-019-02671-4","volume":"37","author":"G Saitta","year":"2019","unstructured":"Saitta G, Becerra JEA, Del Alamo JF, Gonzalez LL, Elbers JR, Suardi N et al (2019) \u201cEn Bloc\u201d HoLEP with early apical release in men with benign prostatic hyperplasia. World J Urol 37(11):2451\u20132458","journal-title":"World J Urol"},{"key":"4959_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-023-04626-2","author":"V Gauhar","year":"2023","unstructured":"Gauhar V, Gomez Sancha F, Enikeev D, Sofer M, Fong KY, Rodriguez Socarras M et al (2023) Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate (REAP) by evaluating trends and outcomes and nuances of prostate enucleation in a real-world setting. World J Urol. https:\/\/doi.org\/10.1007\/s00345-023-04626-2","journal-title":"World J Urol"},{"issue":"9","key":"4959_CR11","doi-asserted-by":"publisher","first-page":"2303","DOI":"10.1007\/s00345-023-04496-8","volume":"41","author":"L Tunc","year":"2023","unstructured":"Tunc L, Herrmann T, Guven S, Scoffone CM, Bozzini G, Yilmaz S et al (2023) A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group. World J Urol 41(9):2303\u20132309","journal-title":"World J Urol"},{"issue":"5","key":"4959_CR12","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1016\/j.eururo.2007.04.074","volume":"52","author":"EA Elzayat","year":"2007","unstructured":"Elzayat EA, Elhilali MM (2007) Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol 52(5):1465\u20131471","journal-title":"Eur Urol"},{"key":"4959_CR13","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.urology.2020.12.023","volume":"149","author":"HC Wright","year":"2021","unstructured":"Wright HC, Fedrigon D, De S (2021) Learning From those who learned: a survey of fellowship trained HoLEP surgeons and their current practice patterns. Urology 149:193\u2013198","journal-title":"Urology"},{"key":"4959_CR14","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16174","author":"AM Shoma","year":"2023","unstructured":"Shoma AM, Ghobrial FK, El-Tabey N, El-Hefnawy AS, El-Kappany HA (2023) Randomized trial of holmium laser vs. thulium laser vs. bipolar enucleation of large size prostate. BJU Int. https:\/\/doi.org\/10.1111\/bju.16174","journal-title":"BJU Int"},{"key":"4959_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2023.06.009","author":"V Gauhar","year":"2023","unstructured":"Gauhar V, Nedbal C, Castellani D, Fong KY, Sofer M, Socarras MR et al (2023) Comparison between thulium fiber laser and high-power holmium laser for anatomic endoscopic enucleation of the prostate: a propensity score-matched analysis from the REAP registry. Eur Urol Focus. https:\/\/doi.org\/10.1016\/j.euf.2023.06.009","journal-title":"Eur Urol Focus"},{"key":"4959_CR16","first-page":"104279","volume":"80","author":"M Yilmaz","year":"2022","unstructured":"Yilmaz M, Karaaslan M, Aybal HC, von Bargen MF, Tonyali S, Toprak T et al (2022) Laser enucleation of the prostate in men with very large glands >\/=175 ml: a systematic review. Ann Med Surg (Lond) 80:104279","journal-title":"Ann Med Surg (Lond)"},{"issue":"7","key":"4959_CR17","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1007\/s00345-021-03598-5","volume":"39","author":"F Rucker","year":"2021","unstructured":"Rucker F, Lehrich K, Bohme A, Zacharias M, Ahyai SA, Hansen J (2021) A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe. World J Urol 39(7):2337\u20132345","journal-title":"World J Urol"},{"issue":"11","key":"4959_CR18","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1007\/s11255-019-02259-2","volume":"51","author":"D Enikeev","year":"2019","unstructured":"Enikeev D, Taratkin M, Laukhtina E, Alekseeva T, Snurnitsyna O, Potoldykova N et al (2019) En bloc and two-lobe techniques for laser endoscopic enucleation of the prostate: retrospective comparative analysis of peri- and postoperative outcomes. Int Urol Nephrol 51(11):1969\u20131974","journal-title":"Int Urol Nephrol"},{"issue":"3","key":"4959_CR19","doi-asserted-by":"publisher","first-page":"218","DOI":"10.4111\/kju.2015.56.3.218","volume":"56","author":"M Kim","year":"2015","unstructured":"Kim M, Piao S, Lee HE, Kim SH, Oh SJ (2015) Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia. Korean J Urol 56(3):218\u2013226","journal-title":"Korean J Urol"},{"issue":"2","key":"4959_CR20","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.euf.2021.03.021","volume":"8","author":"J Franz","year":"2022","unstructured":"Franz J, Suarez-Ibarrola R, Putz P, Sigle A, Lusuardi L, Netsch C et al (2022) Morcellation after endoscopic enucleation of the prostate: efficiency and safety of currently available devices. Eur Urol Focus 8(2):532\u2013544","journal-title":"Eur Urol Focus"},{"issue":"8","key":"4959_CR21","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.1007\/s00345-023-04486-w","volume":"41","author":"T Tricard","year":"2023","unstructured":"Tricard T, Xia S, Xiao D, Tong Z, Gaillard V, Sun J (2023) Outcomes of holmium laser enucleation of the prostate (HoLEP) for very large-sized benign prostatic hyperplasia (over 150 mL): open simple prostatectomy is dead. World J Urol 41(8):2249\u20132253","journal-title":"World J Urol"},{"issue":"4","key":"4959_CR22","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1590\/S1677-5538.IBJU.2015.0477","volume":"42","author":"S Kobayashi","year":"2016","unstructured":"Kobayashi S, Yano M, Nakayama T, Kitahara S (2016) Predictive risk factors of postoperative urinary incontinence following holmium laser enucleation of the prostate during the initial learning period. Int Braz J Urol 42(4):740\u2013746","journal-title":"Int Braz J Urol"},{"issue":"7","key":"4959_CR23","first-page":"801","volume":"37","author":"MM Huang","year":"2023","unstructured":"Huang MM, Dean NS, Assmus MA, Lee MS, Guo JN, Krambeck AE (2023) Intradetrusor onabotulinumtoxina injections at the time of holmium laser enucleation of the prostate for men with severe storage symptoms. J Endourol 37(7):801\u2013806","journal-title":"J Endourol"},{"issue":"1","key":"4959_CR24","first-page":"E39","volume":"17","author":"A Nevo","year":"2023","unstructured":"Nevo A, Cheney SM, Callegari M, Moore JP, Stern KL, Zell MA et al (2023) Median lobe vs. complete gland holmium laser enucleation of the prostate: a propensity score matching. Can Urol Assoc J 17(1):E39\u2013E43","journal-title":"Can Urol Assoc J"},{"issue":"1","key":"4959_CR25","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12894-019-0570-5","volume":"20","author":"G Anan","year":"2020","unstructured":"Anan G, Kaiho Y, Iwamura H, Ito J, Kohada Y, Mikami J et al (2020) Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study. BMC Urol 20(1):3","journal-title":"BMC Urol"},{"issue":"5","key":"4959_CR26","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/luts.12494","volume":"15","author":"M Elsaqa","year":"2023","unstructured":"Elsaqa M, Zhang Y, Papaconstantinou H, Tayeb MME (2023) Incidence and predictors of urinary incontinence rates post-holmium laser enucleation of prostate. Low Urin Tract Symptoms 15(5):185\u2013190","journal-title":"Low Urin Tract Symptoms"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-04959-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-024-04959-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-04959-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T21:30:01Z","timestamp":1735853401000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-024-04959-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,6]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4959"],"URL":"https:\/\/doi.org\/10.1007\/s00345-024-04959-6","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,6]]},"assertion":[{"value":"16 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Fernando Gomez Sancha is a consultant for Quanta System and Lumenis. Thomas R.W. Herrmann is a consultant for, has received honoraria from, and is involved in research collaboration with Karl Storz. The other authors declare no conflict of interest relevant to this submission.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics Board approval data was obtained (AINU #11\/2022).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"299"}}