Safety and Efficacy of a Modified Technique of Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia

Round 1

Reviewer 1 Report

General comments

The authors estimated their HoLEP technique which preserve a portion of prostate proximal to the external sphincter in order to reduce mechanical stress and laser energy widespread on it.

They concluded their modified HoLEP technique might be safe and effective which could significantly improve post-operative urinary continence rate.

This topic is an important area on the surgical treatment for benign prostatic hyperplasia. However, there are several issues need to improve.

The reviewer would like suggests several issues as follows;

Major

#1 The author should describe what are the characteristic parts of their HoLEP technique to make the readers understand by creating a figure or illustration.

#2 The author should describe the characteristics of the surgical technique in abstract part. Otherwise, readers could not understand what kind of surgical technique.

#3 What can be considered a significant improvement in postoperative urinary incontinence? The author should compare with the results before the introduction of their HoLEP technique or with other reports.

#4

The author should describe the anterior prostate preservation techniques and cite the previous reports on anteroposterior dissection techniques such as the below.

Endo F. Urology. 76:1451–1455,2010. Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence.

Anan G. Int Urol Nephrol. 52:1821-1828,2020. Anteroposterior dissection three-lobe technique: an effective surgical method for inexperienced surgeons performing holmium laser enucleation of the prostate.

#5

Please describe why urinary incontinence improves dramatically after 3 months in discussion part.

#6

Please describe methods to improve postoperative urinary incontinence after HoLEP except for surgical techniques such as the below in discussion part.

Anan G. BMC Urol. 20(3):3,2020. Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study.

 

Minor

#1 In Result, p4 line143, There is a difference in the description of operative time and delivered amount of energy between the table and the text.

#2 How about enucleate prostate weight and enucleation efficacy?　Please describe in result part.

Author Response

Dear Reviewer,

Thank you for your valuable suggestions. A point-by-point response has been redacted.

 

Yours Sincerely,

 

Dr. Alessio Paladini

Author Response File: Author Response.docx

Reviewer 2 Report

This is an interesting article describing safety and efficacy of a modified technique of Holmium Laser Enucleation of the Prostate (HoLEP) for benign prostatic hyperplasia. However, certain issues should be amended before it can be accepted for publication in the journal Applied Sciences.

The manuscript is well-written and rather crisp, albeit additional proofreading is suggested to amend minor mistakes. The Introduction section should be rearranged, as it currently discusses several issues and open questions that would fit more to the Discussion section (comparing long-term outcomes of HoLEP and TURP, symptoms after HoLEP, etc.). Study aim should be additionally supported with a certain hypothesis.

In the Materials and Methods section, it is not clear whether this should be considered a prospective or retrospective study (as authors mention both prospective enrollment and retrospective data assessment); as the authors state retrospective nature of the study as one of the main limitations, the true nature of the study should be stated in the first sentence of the Methods section.

Moreover, there is no information whether the study was approved by the Ethics committee, especially since it is a human trial; if so, an approval number and other data should be provided. It is not clear why only a descriptive statistical analysis was pursued, and not analytical (inferential), as the comparsion of certain parameters would provide more comprehensive insights. Furthermore, in the "2.1 Surgical technique" part, the details on antibiotic prophylaxis should be provided. 

Finally, the Discussion section should include some newer studies tackling the same issue. One example is Yılmaz S et al. HoLEP after prostate biopsy: does it have any impact? World J Urol. 2020 Nov 13. doi: 10.1007/s00345-020-03518-z.

Author Response

Dear Reviewer,

Thank you for your valuable suggestions. A point-by-point response has been redacted.

 

Yours Sincerely,

 

Dr. Alessio Paladini

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Thank you for taking into account the suggestions to make this paper better.