# Long-term follow-up of “three horse shoe-like incision (3-HSI) holmium laser enucleation of the prostate: outcomes and efficacy of a novel en-bloc technique for anatomic transurethral prostatectomy”

## TL;DR

A new surgical technique for prostate removal was found to be as safe and effective as traditional methods, with the added benefit of shorter operation time.

## Contribution

The 3-HSI HoLEP technique is introduced as a novel en-bloc method for prostate surgery with improved procedural efficiency.

## Key findings

- The 3-HSI technique had a significantly shorter operative duration compared to the traditional three-lobe HoLEP method.
- Both techniques showed similar safety, efficacy, and patient satisfaction in long-term follow-up.
- No significant differences in complication rates were observed between the two surgical methods.

## Abstract

This study aims to evaluate the long-term outcomes of the novel “three horseshoe-like incision” (3-HSI) technique for holmium laser enucleation of the prostate (HoLEP) compared to the traditional three-lobe HoLEP method in treating benign prostatic hyperplasia (BPH).

A comparative study was conducted of 54 patients undergoing the 3-HSI technique and 27 patients treated with the three-lobe technique from November 2016 to June 2018. All surgeries were performed by a single experienced surgeon. Data were collected preoperatively, perioperatively, and during follow-up. Statistical analyses were conducted using the Wilcoxon rank-sum test and Fisher’s exact test, with significance set at p < 0.05.

Preoperative parameters showed no significant differences between groups, except for a higher symptom burden and medication use in the 3-HSI group. The 3-HSI technique revealed a significantly shorter perioperative operative duration (44.9 ± 43 vs. 60.1 ± 34 min, p = 0.01). Hospital stay, catheterization period, and resected tissue weight were similar. Follow-up data revealed similar functional outcomes and patient satisfaction between groups, with no significant differences in complication rates.

The 3-HSI HoLEP technique demonstrates similar safety and efficacy to the traditional method, with the added benefit of shorter operative time. These findings support the 3-HSI technique as a viable and potentially superior option for BPH surgical intervention.

This trial has been registered in the German Clinical Trials Register DRKS-ID: FRKS005540.

The online version contains supplementary material available at 10.1186/s12894-025-01885-6.