Live En Bloc HoLEP at EAU 2026: The New Kid is En Bloc

March 14, 2026 · London · EAU 2026 · Royal Free Hospital / ExCeL London

 

Today I had the extraordinary honour of performing live en bloc HoLEP surgery at the Royal Free Hospital in London, broadcast in real time to the main auditorium at ExCeL London during the EAU 2026 Congress.

The session — "The New Kid is En Bloc" — demonstrated the en bloc enucleation technique live, with no cuts or edits, while thousands of urologists watched every step on the big screen.

There is no greater validation of a surgical technique than performing it live, in real time, in front of your peers from around the world. The packed auditorium was a testament to the growing interest in en bloc HoLEP as the next evolution of prostate enucleation.

 

What Makes Live Surgery Special

• Complete transparency: Every step visible, every decision explained in real time
• No editing: The audience sees exactly what happens — successes and challenges alike
• Interactive teaching: Moderators and audience can ask questions during the procedure
• Peer validation: When thousands of colleagues watch you operate, the technique speaks for itself

Thank you to the European Association of Urology, the Royal Free Hospital team, Cook Medical, Richard Wolf and Quanta System for making this possible. And thank you to every urologist who was in that auditorium — your interest and enthusiasm are what drive this field forward.

The surgery was a success. The patient is doing well. And en bloc HoLEP continues to prove its place as a game-changing technique in prostate surgery.

Cook Medical Dinner at EAU 2026: The New Kid is En Bloc

March 13, 2026 · London · EAU 2026 · Stratford Hotel, Olympic Park

Last night I had the privilege of presenting "The New Kid is En Bloc: Translating Holmium Laser Physics into Surgical Mastery" at the Cook Medical dinner during EAU 2026 in London.

I shared the podium with Dr. Leye Ajayi, Consultant Urological Surgeon at St John & St Elizabeth Hospital, who delivered an insightful talk on pulse modulation and the Magneto holmium laser technology.

Key Topics Discussed

• En bloc HoLEP technique: Tips, tricks, and how understanding holmium laser physics translates directly into surgical outcomes
• Magneto technology: Advantages in hemostasis and tissue management during enucleation
• The future of holmium laser enucleation: Where the technique and technology are heading

The evening brought together a fantastic group of urologists for lively discussions over dinner. We even raffled copies of the En Bloc HoLEP manual among the participants — always a pleasure to share knowledge beyond the operating room.

Thank you to Cook Medical and Quanta System for organising this memorable event, and to Alan Loughnane and the entire MedSurg Division team for their support.

As Dr. Leye Ajayi wrote on LinkedIn: "Honoured to share the podium with Dr. Fernando Gómez Sancha who gave us an incredible insight, together with tips & tricks on performing en bloc technique for HoLEP."

Looking forward to today's live surgery demonstration at the Royal Free Hospital!

My take on abstracts on Enucleation

March 14, 2026 · London, United Kingdom
41st Annual Congress of the European Association of Urology (EAU26) · ExCeL London

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Dr. Fernando Gómez Sancha · ICUA – Instituto de Cirugía Urológica Avanzada · Clínica CEMTRO, Madrid · March 2026

Introduction

The 41st Annual EAU Congress brought together over 10,000 urologists in London. Among the sessions that caught my attention most, Abstract Session 21 — "Enucleation is enucleation: Comparing efficacies across technologies" — delivered exactly what its title promised: a clear, evidence-based confirmation that endoscopic enucleation of the prostate (EEP) has matured beyond the debate of which laser to use.

I reviewed all 35 abstracts presented at EAU26 that focused on prostate enucleation. What follows is my personal reading of the most relevant findings — and why, in my view, they consistently reinforce HoLEP as the benchmark technique against which all others should be measured.

1. Miniaturisation Has Level-1 Evidence Now

Two independent randomised controlled trials — the MILES trial (A0353) from Sechenov University and A0357 — compared a 22F miniaturised resectoscope (MiLEP) against the standard 26F instrument for laser enucleation. The results were strikingly consistent:

• Enucleation efficiency: equivalent in both arms
• Operative time: no significant difference
• Functional outcomes at 1 and 3 months: comparable
• Early stress urinary incontinence (SUI): 6.5% with 22F vs 29.5% with 26F (p=0.04)

This is the finding of the congress for enucleation surgeons. Two RCTs showing a fourfold reduction in early SUI with the smaller sheath — without any compromise in efficacy — elevates miniaturisation from expert opinion to solid evidence.

From a HoLEP perspective, this is particularly relevant. The holmium laser is perfectly compatible with 22F sheaths, and the anatomical enucleation technique does not require a large working channel. The data from these trials should accelerate the adoption of miniaturised instruments across the field.

2. "Enucleation is Enucleation" — The Data Agree

Multiple abstracts across Session 21 and the Expert-Guided Poster sessions compared different energy sources for enucleation: HoLEP, ThuLEP (pulsed Thulium:YAG), GreenLEP, AEEP. The conclusion is consistent with what experienced enucleation surgeons have been saying for years:

"Enucleation is enucleation." The anatomical plane, not the laser wavelength, determines outcomes.

Abstract P0584 — a prospective non-randomised trial comparing pulsed Thulium:YAG versus Holmium:YAG for enucleation — found equivalent functional results, with Thulium showing marginal advantages in haemostasis. A decade of surgical trends at LMU Munich (A0345) documented the complete transition from TURP to laser enucleation as the institutional standard for BPO management.

My interpretation: the technology choice matters less than the surgeon's command of the anatomical enucleation technique. This is the argument I make in every HoLEP training course I run — the laser is just the tool. The surgical concept is what we are teaching.

3. Tranexamic Acid in Anticoagulated Patients: Practice-Changing Data

Abstract P0731 — a multicenter prospective study by the EAU Endourology Section — is one of the most clinically applicable findings from the entire congress. With 932 patients across 30 centres:

• Intraoperative TXA reduced bleeding complications: OR 0.17 (p<0.001)
• Haemostasis time was significantly shorter in TXA groups
• No impact on functional outcomes at 3 months
• Independent risk factors for bleeding: ongoing anticoagulation (OR 2.93), dual therapy (OR 4.31), longer operative time

For surgeons operating on patients who cannot safely discontinue antithrombotic therapy — a growing population — this evidence provides a practical, low-cost intervention that significantly reduces haemorrhagic risk. Intraoperative tranexamic acid deserves a place in our routine protocol for anticoagulated patients undergoing EEP.

4. Patients and Surgeons Don't Prioritise the Same Things

The ENUC-TR study (P0723) — a multicenter cross-sectional survey across four Turkish urology clinics involving 82 urologists and 622 patients — surfaced a finding that should make every enucleation surgeon pause:

• Surgeons ranked continence as the top priority (45.7%)
• 35.9% of patients placed ejaculation preservation among their top 3 priorities
• 14.8% of urologists did not inform patients about ejaculatory dysfunction before surgery
• 30.9% did not discuss erectile function

No surgeon ranked ejaculation as a first priority. But more than one in three patients did. This is a disconnect we need to address — not by changing what we do surgically, but by changing how we talk to patients before we operate.

In my practice, I discuss ejaculatory outcomes explicitly with every patient considering enucleation. Retrograde ejaculation is an expected consequence in most cases, and patients deserve to understand this — and to factor it into their decision.

5. Bladder Neck Contracture: Predictable and Preventable

A retrospective analysis of 1,740 patients (P0733) identified independent risk factors for bladder neck contracture (BNC) following laser enucleation of the prostate:

• Preoperative urinary tract infection: OR 4.42 (p<0.01) — significant risk factor
• Larger anteroposterior prostatic diameter: OR 0.44 (p<0.01) — protective
• Prediction model AUC: 0.736

The practical message is clear: screen for and treat urinary tract infection before enucleation.

6. The HoLEP Perspective: Why These Results Matter

Reading these abstracts as a HoLEP surgeon and international trainer, what strikes me most is the coherence of the evidence. Every major finding from EAU26 on enucleation reinforces the same message: the technique is what matters.

HoLEP — performed with proper anatomical dissection, with or without a miniaturised sheath, in large or small prostates, in anticoagulated or standard patients — continues to deliver the most robust and reproducible outcomes in the literature.

The debate is no longer HoLEP vs TURP. It's not even HoLEP vs ThuLEP or AEEP. The debate is: how do we train more surgeons to enucleate properly?

At ICUA, we have been running international HoLEP training programmes for surgeons from over 50 countries. What these abstracts confirm is that the investment in anatomical enucleation training — regardless of the laser platform — is the most impactful intervention we can make for patients with benign prostatic obstruction.

Conclusions

1. Miniaturisation (22F) is now evidence-based: same efficacy, significantly less early SUI.
2. "Enucleation is enucleation": anatomical technique, not laser choice, determines outcomes.
3. Intraoperative TXA significantly reduces bleeding risk in anticoagulated patients — a practice-ready finding.
4. Patients care more about ejaculatory function than surgeons assume — pre-operative counselling must improve.
5. Preoperative UTI is a modifiable risk factor for bladder neck contracture — screen and treat before enucleating.

The evidence from EAU26 does not complicate the picture — it clarifies it. Enucleation, done right, is the standard. The challenge now is disseminating the technique.

— Dr. Fernando Gómez Sancha, March 2026
Medical Director, ICUA · Clínica CEMTRO, Madrid
icua.es | @fgomsan

Signing my book - the book sold out!

March 14, 2026 · London, United Kingdom
41st Annual Congress of the European Association of Urology (EAU26) · ExCeL London

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One of the most rewarding moments of EAU 2026 in London was the official presentation and signing of The En Bloc HoLEP Manual — and every single copy sold out.

This manual has been years in the making. It distills more than a decade of experience with en bloc holmium laser enucleation of the prostate, covering everything from surgical anatomy and technique to tips for managing complex cases, large glands, and patients on anticoagulants.

The goal was always to create a practical resource — not just theory, but a step-by-step guide that a urologist could take into the operating room. The kind of book I wished I'd had when I was learning the technique myself.

Why now?

The interest in anatomical enucleation has never been higher. At this year's EAU alone, 35 abstracts were presented on prostatic enucleation techniques. Major centres worldwide are transitioning from TURP to laser enucleation, and the demand for structured training resources continues to grow.

Seeing colleagues from so many countries come to the signing — from Latin America, Asia, Europe, the Middle East — was a powerful reminder that this technique is truly global. And that sharing knowledge is just as important as developing it.

What's inside

• Surgical anatomy of the prostate relevant to en bloc enucleation
• Step-by-step technique with annotated images and diagrams
• Tips and tricks from over 10,000 enucleation procedures
• Managing difficult cases: large glands (>200g), previous BPH surgery, anticoagulated patients
• Learning curve guidance for urologists starting their enucleation journey

Thank you to the EAU for hosting the event, to the publisher for making it happen, and most of all to every colleague who took the time to come by. Your interest and enthusiasm are what make this work worthwhile.

The manual is available for those who couldn't attend — you can find it in amazon and it will be ready to ship in a matter of days!

Presentation of the Manual of En bloc HoLEP at the EAU 26 Congress

After more than two decades performing and teaching en bloc HoLEP across 50+ countries, I am proud to announce that "The En bloc HoLEP Manual" is finally here.

This comprehensive manual covers everything I have learned over 10,000+ laser enucleations — from the anatomical principles that underpin the technique to advanced tips for the most complex cases. It is designed for every urologist who wants to learn or master anatomical en bloc enucleation.

WHERE TO GET IT

EAU26 London — This Friday, March 13th

Limited copies available at the Wisepress stand. I will be there for a "Meet the Author" session — come say hello!

Amazon — Available in Days

The book will be available on Amazon in both English and Spanish within the next few days.

WHAT'S INSIDE

• Step-by-step anatomical en bloc enucleation technique

• Tips for large glands (100g+) and complex cases

• Morcellation strategies and troubleshooting

• Learning curve guidance — from first cases to mastery

• Detailed anatomical illustrations

• My personal experience from 10,000+ procedures in 50+ countries

This book represents my life's work in prostate surgery. I hope it helps the next generation of urologists provide better outcomes for their patients.

See you at EAU!

Originally posted January 30, 2026

Today I performed three live surgical cases for the InaSER Masterclass in Bali, Indonesia. The session was dedicated to teaching advanced endoscopic enucleation techniques. We utilized the Quanta System laser for all procedures. The live cases demonstrated the HoLEP method in a real clinical environment. Attendees from the region observed the surgical workflow directly. I explained specific technical steps during the intervention, focusing on apical dissection and mucosal preservation. The event served as a practical training module for local urologists. The cases were recorded and made available for review in my youtube channel.

Originally posted January 29, 2026

I conducted a 2-day workshop on HoLEP at Ngoehra Public Hospital in Bali, Indonesia. The course included lectures on technique simplification and hands-on training for the participants. Participants practiced the dissection steps using the Holmium laser system. Local urologists from the region attended the event to learn new skills. We covered patient selection and procedural nuances in detail. The session focused on practical experience sharing among the attendees. The hospital facilities supported the training requirements effectively. Several complex cases were discussed during the theoretical part. The feedback from the participants was positive.

Originally posted January 25, 2026

I spent the weekend at Hill Clinic teaching urologists from Turkey en bloc HoLEP. The group included new friends interested in the technique. We focused on the recent advances in Anatomic Enucleation using the Holmium laser. I explained how the procedure is simplified and how to perform early apical dissection. Live surgical cases were discussed to clarify the steps for mucosal preservation. The participants asked specific questions regarding the laser settings and tissue handling.

We completed the training session on Sunday afternoon.

Originally posted January 23, 2026

I updated my recording setup this week. I used the same capture card but connected it to a Mac. I added a simultaneous audio track using Rode Wireless Pro microphones. I also implemented OBS Studio for Mac to manage the stream.

The whole setup is relatively simple and affordable. Grok helped me configure the software. This allows me to record surgical cases or lectures more efficiently. I tested the audio quality during a recent demonstration. The system runs smoothly on the Mac platform. I plan to use this for future webcasts and training sessions.

Originally posted January 21, 2026

I found a nice capture card that allows me to record surgeries directly to my iPad. This will make it easier to document procedures and share surgical techniques with colleagues.