ABSTRACT
OBJECTIVE: To compare the safety, efficacy, and applicability of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral resection of the prostate (TURPb) procedures, whereas the secondary objective is to find out the advantages and disadvantages of each. PATIENTS AND METHODS: A prospective randomized study included 120 patients with benign prostatic hyperplasia that required intervention. The patients were randomized in 2 equal groups: group A managed by HoLEP and group B managed by TURPb. The mean age, International Prostate Symptom Score, maximum urine flow, residual urine, operative time, blood loss, resected volume, catheterization time, hospital stay, and costs were compared. RESULTS: Both groups were comparable regarding the preoperative parameters. The mean operative time was statistically significantly longer in the HoLEP group. The drop in the hemoglobin level was statistically significantly in group B. The mean resected prostatic volume was 61.167 g in the HoLEP group and 58.8 g in the TURPb group. The catheter was removed after 24 hours in 51 and 36 patients in groups A and B, respectively. The International Prostate Symptom Score at 1 and 12 months and the maximum urine flow at 12 months postoperatively were found to be better in the HoLEP group than in the bipolar group, and this difference was found to be statistically significant. CONCLUSION: Although the HoLEP technique is associated with a relatively longer operative time, it has proved to be effective in treating large prostates with minimal morbidity, better hemostasis, less blood loss, and better voiding pattern than TURPb after a 12-month follow-up.
Subject(s)
Cost Savings , Laser Therapy/methods , Lasers, Solid-State/therapeutic use , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Aged , Follow-Up Studies , Humans , Laser Therapy/economics , Length of Stay/economics , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Operative Time , Prospective Studies , Prostatic Hyperplasia/diagnosis , Recovery of Function , Risk Assessment , Transurethral Resection of Prostate/economics , Treatment Outcome , Urination/physiologyABSTRACT
BACKGROUND AND PURPOSE: Holmium enucleation of the prostate (HoLEP) has been established as an effective therapy for patients with benign prostatic hyperplasia (BPH), with less bleeding, shorter catheterization time, and shorter hospital stay. The evolution of the bipolar transurethral resection of the prostate (TURP) raised a question: Would it be able to provide all the advantages of HoLEP and compensate for all its drawbacks, including the higher costs and the steep learning curve? PATIENTS AND METHODS: A randomized study was performed that compared HoLEP with bipolar TURP. The study included 60 patients with BPH who were randomized in two groups (1:1 fashion). The mean age, International Prostate Symptom Score, serum prostate-specific antigen value, maximum urinary flow rate, residual urine, prostate size, operative time, blood loss, resected volume, catheterization time, hospital stay, and intraoperative and postoperative complications were compared in both groups, with a follow-up period of 6 months postoperatively. RESULTS: Both techniques were comparable to each other. They shared the same advantages of decreased perioperative morbidity. The longer operative time in the HoLEP group, however, was still statistically significant. In addition, the expense of performing HoLEP was nearly double that of bipolar TURP. CONCLUSION: HoLEP and bipolar TURP are effective in treating patients with lower urinary tract symptoms due to BPH, however; the long operative time, the steep learning curve, as well as the higher expenses of HoLEP are in favor of bipolar TURP.
