Prospective Results of the Minimally Invasive Laser Enucleation of the Prostate (MiLEP)

Recently, we read an article by Breno et al. [1] with great interest published online in The Prostate. A total of 73 patients were included in this study to the MiLEP procedure. The postoperative urinary continence rate exceeded 95 within 1 week, and at the 6-month follow-up, the urinary continence rate reached 100%. Postoperatively, there was a significant decrease in the IPSS (21.18 vs. 7.92, p < 0.001), and a marked improvement in the Uroflowmetry (mL/s) (9.02 vs. 21.07, p < 0.001) was observed. The mean operative time was 78.5 min, with the average time for removal of the bladder catheter being 18 h postoperatively. The primary challenges in transurethral enucleation of the prostate currently revolve around enhancing surgical efficiency, minimizing urethral injury, and reducing postoperative urinary incontinence complications. The MiLEP [2], particularly with the use of a 22FR laser fiber, represents a significant advancement in the urological management of benign prostatic hyperplasia (BPH). To date, there is a scarcity of descriptions regarding the implementation of MiLEP and associated clinical outcomes. We commend the authors for their additional contributions to the clinical application research of this technology. This commentary aims to delve into the clinical significance and profound implications of MiLEP based on recent prospective studies. Firstly, MiLEP offers a less invasive alternative to traditional prostate surgery, with the use of a 22FR laser fiber allowing for precise enucleation of prostate tissue through a smaller incision. This approach has been shown to reduce intraoperative irrigation requirements, decrease in body core temperature, and lessen the need for meatal dilation compared to the standard 26FR Holmium laser enucleation of the prostate (HoLEP) [3]. These improvements suggest a reduced physical burden on patients undergoing the procedure. Secondly, the prospective results indicate that MiLEP is not only feasible but also effective, with no significant differences in prostatic enucleation effectiveness, operative time, hospital stay, complications, and improvement in the international prostate symptom score and quality of life score when compared to HoLEP [3]. This suggests that while reducing the invasiveness of the procedure, MiLEP maintains the therapeutic benefits associated with HoLEP. Lastly, a noteworthy finding is the trend toward less and a shorter period of postoperative stress incontinence in the MiLEP group compared to the HoLEP group, with statistically significant differences at 1 month postoperatively [4]. This reduction in early postoperative stress incontinence is a critical advantage, as it can significantly impact patient recovery and quality of life. MiLEP emerges as a promising minimally invasive technique for BPH management, offering reduced intraoperative and postoperative morbidities without compromising effectiveness. The potential for improved recovery and reduced complications positions MiLEP as a valuable addition to the urological surgeon's armamentarium. Nevertheless, further validation of these findings necessitates multicenter studies and extended follow-up periods. Fu Feng: project development, literature collection, and manuscript writing. Zhanping Xu: project development and manuscript writing. The authors received no specific funding for this work. The authors have nothing to report. All authors gave consent for the publication of the article. The authors declare no conflicts of interest. The authors have nothing to report.