Benign Prostatic ObstructionHolmium Laser Enucleation of the Prostate Versus Open Prostatectomy for Prostates >70 g: 24-Month Follow-up
Introduction
Open prostatectomy (OP) is the most common surgical approach for benign prostate hyperplasia (BPH) in large prostates in many parts of Europe [1], [2]. For the past 30 yr, the gold standard treatment for smaller prostates has been transurethral resection of the prostate (TURP) [3], but growing evidence suggests that holmium laser with prostate enucleation (HoLEP) can be an effective and safe alternative with overall functional results similar to standard TURP in terms of relief of subjective symptoms and urodynamic findings [4], [5], [6].
The good results achieved with relatively small prostates have also been confirmed with larger glands. In a series of studies, HoLEP was demonstrated to be safe and effective for the treatment of prostates 80–200 g and had encouraging results in terms of short hospital stay and catheterisation time with low perioperative morbidity [7], [8], [9], [10].
Despite the overall good long-term results and the low reoperation rates after OP, the high perioperative morbidity associated with this approach stresses the need to find an adequate alternative that can reproduce the same functional results and drastically reduce morbidity [11]. However, to our knowledge only one prospective randomised study compares OP with HoLEP for prostates >100 g with a minimum follow-up period of 18 mo [12].
Our paper describes the perioperative findings and 2-yr follow-up results that compare HoLEP and OP for the treatment of patients with urodynamically obstructed BPH with prostates >70 g.
Section snippets
Patients and methods
From March 2003 to December 2004, 80 consecutive patients who suffered from BPH-related obstructed voiding symptoms with prostate volume >70 g, as determined by transrectal ultrasound (TRUS), and who had not responded to pharmacologic therapy were considered eligible for surgical treatment and enrolled in this randomised prospective study. The following inclusion criteria were considered: postvoiding residue <150 ml, peak urinary flow rate <15 ml/s, and urodynamic obstruction (Schäfer grade > 2).
Results
The main characteristics of the patients are shown in Table 1. Time in the operating room was significantly longer for the HoLEP group; catheter removal and hospital stay were significantly shorter in the HoLEP group than in the OP group. Table 2 lists perioperative results from both groups. Blood loss was less (p = 0.0073) and blood transfusions were fewer in the HoLEP group both in terms of autologous (p < 0.001) and homologous (p < 0.007) transfusions. Only one patient from the HoLEP group
Discussion
HoLEP with morcellation has gained increasing credibility as a therapeutic option for bladder outlet obstruction (BOO) caused by symptomatic BPH and has been demonstrated to be at least as reliable and efficacious as TURP for small- to medium-sized prostates [5], [6], [7]. Many authors have described the feasibility and safety of the procedure in patients with larger prostates, especially since the introduction of the morcellator [4], [5], [6], [7], [8], [9], [15]. These results have launched
Conclusions
HoLEP is a safe and minimally invasive technique for the treatment of small and large prostates. Even though HoLEP takes longer to perform than OP, it is associated with reduced perioperative morbidity, significantly shorter catheterisation, and a shorter hospital stay. Furthermore, functional results are comparable at the 2-yr follow-up; thus, HoLEP is an attractive alternative to OP.
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