Comparison of holmium laser enucleation prostatectomy and open transvesical prostatectomy in large prostate more than 80 g in Egyptian men: a randomized controlled trial

Abstract

Objective The aim was to assess the safety and efficacy of holmium laser enucleation prostatectomy (HoLEP) vs open prostatectomy (OP) for prostate of more than 80 g owing to benign prostatic hyperplasia in Egyptian men regarding micturition parameters and complications. Patients and methods A total of 110 patients were randomly divided into HoLEP (55 patients) and OP (55 patients). The inclusion criteria were American Urological Association-Symptom Score (AUA-SS) of eight or higher, maximum urinary flow rate (Qmax) of 10 ml/s or less, postvoiding residual urine (PVUR) of 50 ml or more, and a total prostate volume of 80 ml or more in transrectal ultrasound. The exclusion criteria included previous prostate or urethral surgery and non-benign prostatic hyperplasia related voiding disorders. Follow-up was done at first week, second week, first month, third month, sixth month, and 12th month postoperatively. Perioperative parameters were operative time, enucleation specimen weight, postoperative hemoglobin, length of hospital stay, and the duration of indwelling catheter. The assessment was done in the form of AUA-SS, Qmax, PVUR, and reported complications. Results Operative time was statistically significantly shorter in HoLEP compared with OP (102.45 vs 170.45 min, respectively). Drop-in hemoglobin concentration was statistically significantly higher in OP compared with HoLEP. Moreover, the duration of catheterization and hospital stay were statistically significantly shorter in HoLEP compared with OP. On the contrary, AUA-SS, PVUR, and Qmax did not reveal statistically significant differences between the two groups. Conclusion Both modalities have similar efficacy; however, HoLEP was superior to OP regarding hospital stay, the duration of catheterization, and the rate of hemoglobin concentration drop.