Versapulse power suite

The HoLEP procedures used were as previously described [3 (link)]. In brief, a “three-lobe” technique was used. A 26-Fr resectoscope (Karl Storz GmbH & Co, Tuttlingen, Germany) was inserted into the prostate and bladder. Enucleation of the prostate was performed using a 550-μm end-firing laser fiber (SlimLine, Lumenis Ltd, Yokneam, Israel) and an 80-W holmium neodymium: yttrium-aluminum-garnet laser (VersaPulse Power-Suite, Lumenis Ltd). The laser setting was 2 J and 40 Hz. A continuous saline solution irrigation was applied during the enucleation and morcellation. The enucleated tissue was retrieved using a VersaCut morcellator (Lumenis Ltd.) through a 0-degree rectangular nephroscope (Karl Storz GmbH & Co.). At the end of the operation, a 3-way 22-Fr urethral Foley catheter was inserted for continuous bladder irrigation. All retrieved tissues were weighed and examined histologically. Urethral catheters were typically removed on the first or second postoperative day after confirming clear urine color without significant gross hematuria. Patients were divided into 4 cohorts based on age as group A, 50–59 years, group B, 60–69 years, group C, 70–79 years, and group D, ≥80 years.

The equipment used was a Holinwon Prima (Wontech Co. Ltd.) with a maximum output of 30 W. LP HoLEP was set to 24 W (2 J, 12 Hz). The HP equipment was a Ho:YAG laser generator (Versapulse PowerSuite; Lumenis Ltd.). The HP HoLEP group was set to 80 W (2 J, 40 Hz). A 550-µm end-firing fiber (SlimLine 550; Lumenis Ltd.) was used in both groups.
HoLEP was performed based on the classical three-lobe technique with an early inverted V-shaped apical mucosal incision, as previously described [15 (link)16 ]. There were no differences in the surgical approach between the high-power and low-power settings.

All surgical procedures were performed in a routine manner by one urologist (SJO) with the experience of performing more than 100 HoLEP operations as described in detail in previous studies.13 (link)14 (link) First, a 26 Fr resectoscope (Karl Storz GmbH and Co., Tuttlingen, Germany) was inserted into the prostate and bladder. Normal saline was irrigated continuously during enucleation and morcellation. Enucleation of the prostate was performed using a 550-μm end-firing laser fiber (SlimLine, Lumenis Ltd., Yokneam, Israel) and an 80 W holmium neodymium: yttrium-aluminum-garnet laser (VersaPulse Power-Suite, Lumenis Ltd.). Second, tissue morcellation was performed with a VersaCut morcellator (Lumenis Ltd.) through a 0° rectangular nephroscope (Karl Storz GmbH and Co.). At the end of morcellation, a 22 Fr 3-way urethral catheter was inserted into the bladder, and normal saline was connected to the catheter for continuous irrigation.
The urethral catheter was generally removed on the 1^st or 2^nd postoperative day. The patients were discharged if they were able to void without problems and had postvoid residual urine volumes of <50 ml. The pre- and post-operative data, including the parameters of energy used, operative time, duration of hospital stay, intra- and post-operative complications, and duration of urethral catheterization were assessed.

All surgical procedures were performed by one surgeon (S.J.O.) according to the technique described previously [10 (link)]. In brief, anatomical enucleation was adopted using the three-lobe technique. A 26-Fr resectoscope (Karl Storz, Tuttlingen, Germany) was used for enucleation of the prostate. A 550-μm end-firing laser fiber (SlimLine, Lumenis Ltd., Yokneam, Israel) was engaged with an 80-W holmium neodymium:yttrium-aluminum-garnet laser (VersaPulse Power-Suite, Lumenis Ltd.). The energy power was usually set at 2 J and 40 Hz. Continuous irrigation was applied with normal saline during enucleation and morcellation. The mechanical morcellator used was a VersaCut morcellator (Lumenis Ltd.) through a 0-degree rectangular nephroscope (Karl Storz). If the lump was small, it was washed out through the resectoscope sheath naturally. After complete retrieval of the enucleated prostatic tissue from the bladder, usually a 22-Fr 3-way urethral catheter was inserted for continuous bladder irrigation with normal saline. At the end of the operation, the extracted tissues were weighed after removing the irrigation fluid and sent for pathological analysis.