How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate?

Abstract

Introduction International Prostate Symptom Score (IPSS) is a validated outcome measure for the evaluation of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). When treating patients with transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), patient selection is key to achieve the best clinical outcome. Therefore, we analyzed how the severity of LUTS as determined by IPSS influenced postoperative functional outcomes. Material and methods We conducted a retrospective, matched-pair analysis of 2,011 men who underwent HoLEP or TURP for LUTS/BPO between 2013–2017. We included 195 patients in the final analysis (HoLEP n = 97; TURP n = 98), who were matched for prostate size (50 cc), age, and body mass index. Patients were then stratified by IPSS. Groups were compared for perioperative parameters, safety and short-term functional outcomes. Results While preoperative symptom severity was a significant predictor of postoperative clinical improvement, patients who received HoLEP showed superior postoperative functional results with higher peak flow rates and 2-fold greater improvement in IPSS. In patients presenting with severe symptoms, we observed 3- to 4-fold less Clavien-Dindo grade ≥II and overall complications after receiving HoLEP compared to TURP. Conclusions Patients with severe LUTS were more likely to experience clinically significant improvement after surgery than patients with moderate LUTS, and HoLEP showed superior functional outcomes than TURP. However, patients with moderate LUTS should not be denied surgery, but may warrant a more comprehensive clinical work-up.

Efficacy, efficiency, and safety of en-bloc vs. three-lobe enucleation of the prostate: a propensity score-matched analysis

“…With recent introductions of different HoLEP techniques, such as the en-bloc, two-lobe, or "omega" resection [13,14], there are only a limited number of studies focusing on comparing perioperative data and postoperative functional outcomes, and the exact differences or benefits of either technique remain mainly unclear [15,16]. As patients and practitioners alike, have a variety of treatment options to choose from when medical treatment for LUTS/BPO fails or is not feasible [7,17,18], a closer look at the underlying technique, further expanding the benefits of laser enucleation, becomes mandatory. While there certainly is no doubt about the benefits of HoLEP compared to TURP or OP, some technical aspects have still been up for discussion.…”

“…Thus, leading to clinically relevant LUTS secondary to BPO. Introduced in 1996, Holmium laser enucleation of the prostate (HoLEP) is nowadays recommended by both American Urological Association (AUA) and European Association of Urology (EAU) guidelines on the management of non-neurogenic male LUTS as sizeindependent endoscopic treatment method [3][4][5][6][7][8], and detailed understanding of its benefits is mandatory. Therefore, we assessed efficacy, efficiency, and safety of HoLEP by directly comparing intraoperative performance, postoperative outcomes, and safety in the original three-lobe enucleation technique with the more recent en-bloc method [8].…”