Sphincter-preserving HoLEP

The critical anatomy

During enucleation, the surgeon must separate adenoma from the surgical capsule while approaching the apex where the continence mechanism is nearby. This is one of the parts of HoLEP where judgement, visual recognition of tissue planes and controlled dissection are particularly important.

What does “sphincter preserving” mean?

The objective is to release apical adenoma while avoiding unnecessary traction or energy close to the external sphincter and preserving functional urethral tissue where appropriate. Different experienced surgeons may use different technical modifications to achieve the same principle.

How this fits with en-bloc HoLEP

In an en-bloc technique, the adenoma is progressively mobilised as a single anatomical unit rather than treated as unrelated fragments. The exact sequence varies by surgeon, but maintaining orientation and planning the apical release remain central to sphincter-conscious surgery.

Does this eliminate incontinence?

No technique can promise zero postoperative leakage. Continence is influenced by pre-operative bladder and sphincter function, prostate anatomy, operative factors and recovery. Sphincter-preserving technique is intended to respect the continence mechanism, not to guarantee an outcome.