الفهرس 
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Abstract
Introduction and review of literature: HoLEP is a size-independent gold standard for management of BPO. It was initially described by Gilling as three lobe technique then several modifications were adopted to improve post-operative continence and facilitate learning. En-bloc technique was introduced by Scoffone et al aiming at reduction of operative time and easing learning curve. Aim of the work: To compare between en-bloc vs. conventional Lobe by lobe HoLEP through a RCT. Patients and Methods: A randomized controlled trial were a total of 123 eligible patients with prostate size above 80ml were randomized to either lobe-by-lobe (63 patients) or en-bloc (60 patients). Patients were assessed preoperatively, 1,3 and 6 months postoperatively. Patients’ baseline characteristics, perioperative data, postoperative outcomes, and complications were recorded . Operative efficiency (resected weight/operative time) and enucleation efficiency (resected weight/ enucleation time) were calculated. Primary endpoint was enucleation efficiency. Secondary endpoints included: other operative efficiency measures, blood loss, hospital stay, perioperative complications and postoperative urinary outcomes (IPSS, QOL, Qmax, PVR and transient SUI). Results:. In both groups, the mean IPSS and QoL showed significant improvement at follow up visits compared to preoperative values with no significant differences between both groups.mean enucleation and operative efficiency were comparable between both groups.The overall complications rate was also comparable.The incidence of significant transient SUI at 3 months was comparable. Conclusion: En-bloc HoLEP is comparable to conventional lobe-by-lobe HoLEP in terms of enucleation efficiency, operative efficiency, overall complications rate and incidence of transient post-operative SUI. Recommendations: Larger prospective studies are still needed to compare the efficiency and the learning curve of different techniques for HoLEP, and explore the rule of EAR in reducing the incidence of post-operative SUI and promoting early recovery.