Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy

Abstract

Purpose of ReviewThis study reviews contemporary literature on RASP and HoLEP to evaluate perioperative outcomes, common complications, cost analytics, and future directions of both procedures. Recent Findings RASP is indicated for prostates > 80 mL, while HoLEP is size-independent. No notable differences were found in operative time, PSA nadir (surrogate for enucleation volume), re-catheterization rates, or long-term durability. Prolonged incontinence and bladder neck contracture rates are low for both surgeries. Patients experience similar satisfaction outcomes and improvements in uroflowmetry and post-void residual volumes. HoLEP demonstrates shorter hospitalizations, lower transfusion rates, lower costs, and higher rates of same-day discharge. RASP offers a shorter learning curve and lower rates of early postoperative urinary incontinence. Summary HoLEP is a size-independent surgery that offers advantages for patients seeking a minimally invasive procedure with the potential for catheter-free same-day discharge. Future directions with single-port simple prostatectomy may offer parity in same-day discharge, but further research is needed to determine broader feasibility.

High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group

“… 6 Although minimally invasive approaches such as laparoscopic or robotic simple prostatectomy has been advocated for prostates >80 ml, 7 , 8 recent evidence has demonstrated that EEP with HL is as safe and equally effective with shorter hospitalizations, lower transfusion rates, shorter catheterization time, lower costs, and even feasible for same-day discharge. 9 However, most of the published studies include single-center series with the majority of the large prostate volumes ranging between 80–100 ml with even fewer studies report outcomes for prostate volumes of more than 150–200 ml. 5 , 10 , 11 …”

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

“…EAU, NICE, and AUA guidelines recommend laser-based EEP for prostates larger than 80 ml a reference standard being currently held for large prostates [ 8 ]. Recently, laparoscopic or robotic simple prostatectomy has been advocated for prostates > 80 cc with pros and cons for each [ 9 ] but even for large prostates HoLEP is as safe and equally effective and offers shorter hospitalizations, lower transfusion rates, shorter catheterization time, lower costs, and even feasible for same-day discharge [ 10 ]. However, most of the published studies included single-center series with the majority of the large prostate volumes ranging between 80 and 100 ml.…”

Prostatachirurgie beim benignen Prostatasyndrom >200 ml: Endoskopisch, robotisch oder doch offen?

“…Im Vergleich zur RAE fallen bei AEEP niedrigere Personalkosten an, da in der Regel nur ein Operateur und 1-2 Pflegekräfte benötigt werden. Zudem sind die Investitions-und vor allem die Sachkosten deutlich geringer [34]. Somit ist davon auszugehen, dass die AEEP der deutlich kosteneffizientere Eingriff ist.…”