Introduction & objectives:
\nHolmium Laser Enucleation of the Prostate (HoLEP) is performed under general or spinal anesthesia; however, whether the anesthetic technique affects the efficiency and completeness of gland enucleation or the frequency of complications remains unclear. We compared three anesthesia modalities in a national multicenter prospective registry, applying inverse probability of treatment weighting (IPTW) to balance baseline differences.
\nMaterials & methods:
\nBetween May 2025 and April 2026, patients were enrolled in the Registry of Minimal Invasive Urology Society in Turkey (NCT07585552). Of 606 patients, 196 were excluded for incomplete follow-up or missing data, leaving 410, grouped by anesthesia type: general anesthesia with laryngeal mask airway (LMA, n=121), general anesthesia with endotracheal intubation (n=173), and spinal anesthesia (n=116). IPTW balanced seven baseline covariates, including age, comorbidity, prostate volume, and symptom scores (maximum standardized mean difference 0.072). Three intraoperative metrics were defined: enucleation efficiency (tissue weight per enucleation minute), morcellation efficiency (tissue weight per morcellation minute), and the enucleation ratio (tissue weight relative to preoperative prostate volume). Complications and 1-month functional change were also assessed. Weighted nonparametric tests with bootstrap confidence intervals were used.
\nResults:
\nAfter weighting, prostate volume was similar across groups (p=0.11). The intubated group had the highest enucleated tissue weight (p<0.001), enucleation efficiency (p=0.006), enucleation ratio (p<0.001), and morcellation efficiency (p<0.001). Complication rates were similar: Clavien-Dindo grade (p=0.397), capsular perforation, bladder injury, and clot retention did not differ across groups. Symptom relief at one month (\u0394IPSS, \u0394QoL) was greatest in the intubated group (p<0.001).
\nConclusions:
\nWith baseline characteristics balanced by IPTW, endotracheal intubation and general anesthesia were associated with higher operative efficiency, a higher enucleation ratio, and greater 1-month improvement in IPSS, QoL, and Qmax during HoLEP, without an increase in complications. These associations may reflect the more stable operating conditions that controlled ventilation and deeper muscle relaxation can provide, although enucleation technique and center-level practice may also contribute.<\/p>","protected":false},"excerpt":{"rendered":"
Introduction & objectives: Holmium Laser Enucleation of the Prostate (HoLEP) is performed under general or spinal anesthesia; however, whether the anesthetic technique affects the efficiency and completeness of gland enucleation or the frequency of complications remains unclear. We compared three … read more<\/a><\/p>","protected":false},"author":3,"featured_media":345,"menu_order":0,"template":"","meta":{"_acf_changed":false},"portfolio-type":[19],"portfolio-tag":[],"class_list":["post-344","portfolio","type-portfolio","status-publish","has-post-thumbnail","hentry","portfolio-type-unmoderated-posters"],"acf":[],"_links":{"self":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio\/344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio"}],"about":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/types\/portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/users\/3"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media\/345"}],"wp:attachment":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media?parent=344"}],"wp:term":[{"taxonomy":"portfolio-type","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-type?post=344"},{"taxonomy":"portfolio-tag","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-tag?post=344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}