Holmium Laser Enucleation of the Prostate vs Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands

Abstract

To compare the perioperative outcomes of transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP). A retrospective review was performed of patients undergoing SP-RASP and HoLEP from 2019 to 2022 with preoperative prostatic volume (PPV) >80cm3. Percent of prostate adenoma removed (%PAR) was estimated by specimen weight normalized by PPV. Univariate analysis was performed using chi-square, Fisher exact, and Wilcoxon rank-sum tests. A subgroup analysis with 1:1 matching for PPV was also performed. A total of 50 SP-RASP and 90 HoLEP cases were analyzed. The median (interquartile range) PPV was 169 (128-244)cm3 for SP-RASP and 129 (100-150)cm3 for HoLEP, (P<.01). The median (interquartile range) %PAR was 57(44-68) for SP-RASP vs 51(42-62) for HoLEP (P=.10). Overall, 11(12%) HoLEP and 5(10%) SP-RASP patients experienced complications (P=.51). Same-day discharge occurred in 24(48%) SP-RASP vs 7(8%) HoLEP patients (P<.01). Median foley catheter duration was longer in SP-RASP (6 vs 1day, P<.01) and trial of void was successful at first attempt in >94% (P=.68). Transient de novo incontinence was reported in 24(28%) HoLEP vs 2(5%) SP-RASP (P<.01). No differences in voiding parameters were observed at latest follow up. Subgroup postmatched analysis revealed analogous findings. SP-RASP and HoLEP have similar favorable perioperative outcomes for management of large prostatic adenomas. SP-RASP may be considered in patients unwilling to accept the risk of transient incontinence and in those with unfavorable urethral access, large bladder stone burden, or diverticula.