Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP

Abstract

Summary Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post‐operative complications were compared between groups in the post‐operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p ≤ .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.

Current evidence of ThuLEP for BPH: A review of literature

“…However, ThuLEP was superior in terms of total operative time, laser efficiency, enucleation time, and enucleation efficiency. 41 Compared to Bozzini et al, 49 no significant differences were found in terms of postoperative stress incontinence or AUR.…”

“…Various studies have shown the feasibility and efficacy of ThuEP in the treatment of large prostates. [37][38][39][40][41] One study by Becker et al 39,42 showed that outcomes were sustained at 4-year follow-up with only 1/90 patients requiring retreatment and 3/90 patients requiring treatment for urethral stricture or bladder neck contraction. Nevertheless, very few studies comparing ThuEP and OP were found in our research.…”

“…Enikeev et al 41,44 performed a retrospective comparison between OP (40 patients) and ThuFLEP (90 patients). Mean operative time, resected tissue weight, and resection speed were similar.…”

“…Recently, Kaya et al 41 compared HoLEP (121 patients) and ThuLEP (104 patients) in the treatment of prostates larger than 100 cc. Both procedures significantly improved IPSS, QoL, Q max , and PVR with no significant differences between the two, maintaining a low complication rate.…”

“…This could be related to increased traction on the external sphincter while performing HoLEP and to the higher thermal damage caused by the deeper penetration of the holmium laser. However, Kaya et al 41 suggested that these results could be due to the technique, rather than laser features. Studies with long-term follow-up (!3 years) are needed to compare disease recurrence, late complications, and stability of results between ThuEP and HoLEP.…”