الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
BPH is the most common cause of LUTS in elderly men.
Endoscopic enucleation of the prostate is an anatomical enucleation that mimics the surgeon’s index finger that is developed to overcome the morbidity of TURP in large prostatic adenoma
The first enucleation was done by Hiraoko in 1983 using a monopolar resection. Gilling in 1998, he developed the first HoLEP technique. In 2004, Neill demonstrated the first BPEP. In the late 2000s, all other laser-based enucleation techniques started to develop .
The Ho: YAG laser is a pulsed laser of a wavelength of 2140 nm. The laser energy is mainly absorbed by water from the irrigation fluid and in the cells and extracellular space in the tissue which leads to a very short penetration depth into the (prostatic) tissue (~0.4 mm) .
Refinement of the HoLEP technique was done by Bazeem et al, in 2009 with blunt dissection and early separation of the adenoma proximal to the sphincter.
Enucleation is a size-independent surgical technique regardless of the energy source being used and depends mainly on the surgeon’s skills.
Summary
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Commercial consideration rather than science probably be the major determining factor in choosing the energy source.
Both HoLEP and BPEP are safe and effective in the surgical management of large prostatic adenomas .
There is no clear consensus on the accurate definition of the learning curve. It is assumed it is the ability to perform a safe and effective procedure with a favorable outcome, so it is a moving target with continuous improvement in the outcome.
HoLEP represents a retrograde laser-assisted dissection of the prostatic adenoma followed by an intravesical morcellation.
High power HoLEP has a more cutting effect while low power HoLEP has less bleeding and less energy dispersion with less collateral damage .
Early adenoma separation proximal to the sphincter with a mucosal strip using a low power HoLEP spares sphincteric affection from the traction force or the energy source .
BPEP is a hybrid technique of Enucleation and resection .
BPEP demands a longer learning curve and assumed to have a longer operative time due to the formation of vaporization bubbles that obscure the point of contact and the continuous need to stop .
Summary
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BPEP is considered less hemostatic that demands more irrigation and more hospital stay .
HoLEP has a shorter catheterization time, hospital stay and more cost-effectiveness than BPEP .
HoLEP is more cost-effective than open prostatectomy and BPEP
Recurrence of urine retention following prostatic enucleation may be related to one of the following factors, residual adenoma, meatal stenosis, urethral stricture or bladder neck contracture,
HoLEP has 95% reoperation-free probability at 10 years. The relatively small-size prostate may have an impact on the recurrence of adenoma and bladder neck contracture. PSA reduction < 50% after 3 months was significantly associated with recurrence of adenoma while longer operative time and postoperative catheterization were significantly associated with postoperative urethral stricture.