Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g

Abstract

antigen (PSA) level estimation, the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q max ), and transabdominal ultrasonography to estimate prostate size and postvoid urine residue (PVR). The operative duration, blood loss, resected tissue weight, change in levels of haemoglobin and serum sodium, nursing contact time, duration of catheterization, and complications were noted. After surgery patients were reassessed for the IPSS, Q max and PVR at 6 months and 1 year. RESULTSThe patients in all three groups had comparable characteristics before surgery. The mean operating duration and intraoperative irrigant used for TUVRP was less than for HOLEP or TURP, and blood loss with HOLEP and TUVRP was less than with TURP (all P < 0.001). Postoperative irrigation, nursing contact time, and catheter duration were significantly less for HOLEP than TURP or TUVRP, and for TUVRP than TURP. At followup, patients in all groups had a significant improvement from baseline in IPSS, Q max, and PVR, but the differences between the groups were not significant at 6 months or 1 year. CONCLUSIONSHOLEP and TUVRP are both acceptable alternatives to TURP for treating large prostate glands, with less perioperative morbidity and comparable efficacy at 6 months and 1 year.

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

“…Randomized control studies have shown that symptom improvement attained after HoLEP is comparable to that obtained following TURP, with favorable results including removed tissue weight, duration of catheterization, hospital stay, need for blood transfusions, and the absence of TURP syndrome (4,5,(17)(18)(19). Similar treatment outcomes have been demonstrated when HoLEP was compared to open prostatectomy for the treatment of large prostates.…”

“…Compared to TURP or open prostatectomy, HoLEP has similar clinical outcome, lower postoperative complication rate and requires shorter hospital stay (4)(5)(6)(7)(8). In addition, HoLEP appears to be a true endourological alternative to open prostatectomy, because it can effectively treat a very large prostate (9,10).…”

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“…For catheterization time, we found no significant difference between HoLEP and TURP, although Holmium laser technique is considered significantly shorter [11,[13][14]. As for operating time, HoLEP has a longer surgery time due to prolonged morcellation which is similar to other related studies [10][11][14][15][16]. Longer operation time in HoLEP might be associated with removal of more prostatic tissue by HoLEP than TURP and prolonged morcelation time.…”

“…In the present study, we report our experience of HoLEP compared to TURP. Advantages of HoLEP such as; increased removal of tissue amount, shorter bladder irrigation time and fewer perioperative complications are similar to other studies [10][11][12][13][14][15][16]. For catheterization time, we found no significant difference between HoLEP and TURP, although Holmium laser technique is considered significantly shorter [11,[13][14].…”

Case series: Bladder clot evacuation using a prostate morcellation device

“…[1][2][3][4][5][6][7] Blood clots within the bladder postoperatively can be removed by a number of methods, including hand irrigation through a Foley catheter or cystoscopic evacuation with an evacuation device. [8][9][10] Large, organized blood clots within the bladder causing urinary retention that are refractory to these classic management techniques pose a significant challenge to the surgeon.…”