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

Giorgio Bozzini,Tahsin Batuhan Aydoğan,Umberto Besana,Salvatore Micali,Matteo Maltagliati,Maria Chiara Sighinolfi,Jean Baptiste Roche,Alberto Calori,Bernardo Rocco,Antonio Luigi Pastore,Alexander Müller,Lorenzo Berti,Pierluigi Bove,Carlo Buizza

doi:10.1007/s00345-020-03468-6

Abstract

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. 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 12months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Qmax). Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66min, p = 0.245), enucleated tissue weight (48.84 vs 51.13g, p = 0.321), catheterization time (1.9 vs 2.0days, p = 0.450) and hospital stay (2.2 vs 2.8days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77g/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, Qmax, PVR, IPSS and QoL score during follow-up. 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.

Highlights

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men [1]
Over the past 3 decades lasers have become increasingly popular amongst urologists in the endoscopic treatment of BPH, trying to find an alternative to transurethral resection of prostate (TURP), due to its complications, such as bleeding, voiding dysfunction and transurethral resection syndrome (TURS) and to its limitation in treating large prostates [3]
Haemoglobin drop was significantly lower in the ThuLEP group (Table 2)

Summary

Introduction

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men [1]. Accepted medical treatments for moderate to severe LUTS are alpha-blockers and 5-alpha-reductase inhibitors, in single, or combination therapy, depending on prostate volume. The choice between classical surgical treatments mainly depended on prostate size: transurethral incision of the prostate for prostates < 30 cc, mono or bipolar transurethral resection of prostate (TURP), for prostates between 30–80 cc and open prostatectomy (OP) if > 80 cc. For decades TURP has been the standard of care in the treatment of prostates < 80 cc. Over the past 3 decades lasers have become increasingly popular amongst urologists in the endoscopic treatment of BPH, trying to find an alternative to TURP, due to its complications, such as bleeding, voiding dysfunction and transurethral resection syndrome (TURS) and to its limitation in treating large prostates [3]

Methods

Results

Discussion

Conclusion