A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP)

Abstract

Purpose To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. Methods A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Q max ). Results Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Q max , PVR, IPSS and QoL score during follow-up. Conclusion ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference.

Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP

“…Intraoperative and postoperative complications not show any differences at 3 and 12 months of follow-up (Bozzini et al, 2020). Similarly, in our study, no difference was found between groups in terms of post-operative functional results.…”

“…In 2020, Bozzini et al conducted a multicentre, prospective and randomised matched‐pair analysis comparing HoLEP and ThuLEP. In terms of Qmax, PVR, IPSS and QoL score, the procedures did not show any differences at 3 and 12 months of follow‐up(Bozzini et al., 2020). Similarly, in our study, no difference was found between groups in terms of post‐operative functional results.…”

“…It has been reported that both HoLEP and ThuLEP are safe procedures, but acute urinary retention (AUR), blood transfusion rates and SUI rates were significantly higher in the HoLEP group (Bozzini et al., 2020). For AUR and SUI rate, Holmium laser tears the adenoma and capsule tissue with its pulse output feature and causes the mechanical effect of the resectescope´s tip to be used more.…”

Learning curve of ThuLEP (Thulium laser enucleation of the prostate): Single‐centre experience on initial consecutive 60 patients

“…However, the high cost of treatment and the steep learning curve for the clinician have limited the usage of the technique (Razzak, 2013). In the last decade, two laser prostate enucleation techniques, the holmium laser enucleation of the prostate (HoLEP) and the thulium laser enucleation of the prostate (ThuLEP) have gained popularity with comparable successful results (Bozzini et al, 2020).…”

TURPxit or not: contemporary management options for benign prostatic obstruction

“…Since 2008, the debate whether Holmium or Thulium is the greater asset when it comes to AEEP is open. The group of Giorgio Bozzini [24] added another piece of information providing Table 1 Requirements for widespread implementation adapted from Speakman MJ et al [5] Concept/physics and anatomical considerations are sound Proof of concept study Placebo/sham comparison study Randomised controlled trial against accepted alternative treatment Cohort studies: to understand the generalisability and potential harms Systematic reviews and meta-analysis of high-quality primary studies How many patients should be included?-a sample size determination is needed What should be the length of follow-up? Short term: < 12 months, medium 12-36 months and long term > 36 months Inclusion and exclusion criteria need to allow good generalisability Relevant outcomes-varied and need to be clearly outlined from the start the data from a multicenter RCT comparing HoLEP with ThuLEP.…”