Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up

Abstract

Purpose: Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc. Methods: This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis. Results: In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications. Conclusion: There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

“…To the best of our knowledge, studies comparing these 3 procedures in the same paper in terms of effectiveness and complications are limited. However, various studies have indicated that the IPSS and Q max results of these methods and also the complication rates are similar [3, 4, 7, 15, 20]. We found the functional results and complication rates of all 3 surgical procedures to be similar in accordance with the literature.…”

Minimally invasive simple prostatectomy in the era of laser enucleation for high-volume prostates: A systematic review and meta-analysis

“…For HoLEP, the conventional Gilling technique was used. The summary of the preoperative parameters for the different studies are listed in Table 1 [1, [14][15][16][17][18].…”

“…A 3-month follow-up was completed in four studies, with statistically comparable post-surgical outcomes (IPSS, PSA level, Q max and PVR) on meta-analysis ( Figure 3 [14][15][16][17]). Only one study [15] continued follow-up to 6 months after surgery, with comparable IPSS [mean (SD) 4.05 (1.23) in the ELEP group vs 4.70 (0.73) in the LSP group, P = 0.052], but a statistically lower PVR in favour of laser enucleation [mean (SD) 33.9 (9.26) vs 44.5 (15) mL, P = 0.011).…”

Endoscopic transvesical adenomectomy of the prostate, a new minimal invasive approach for large benign prostatic hyperplasia. What has our experience taught us?

“…However, its high learning curve has limited its widespread acceptance and utility, thus simple prostatectomy is still the most disseminated procedure [ 13 , 14 , 15 ]. However, simple prostatectomy is associated with some cons such as bleeding, long hospital stay, and catheterization time [ 16 ]. To overcome these disadvantages, a new minimally invasive technique was developed in our centre, the ETAP.…”

“…These numbers are comparable to open surgery and HoLEP [ 4 , 15 , 18 ]. One of the major concerns with HoLEP is the higher incidence of urge LUTS and pollakiuria which is bothersome in more than 20% of the treated population [ 16 ]. These kinds of symptoms tend to decrease with time, however data on the real impact of hyperactive syndrome complications on patient satisfaction rate is scarce.…”