Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: A prospective randomized study

Abstract

Aim:Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g.Materials and Methods:This prospective randomized study includes 164 patients. Inclusion criteria were age <75 years after failed or poor response to medical therapy, prostatic size >60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery.Results:Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up.Conclusion:HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria.

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial

“…This kind of prospective feasibility study needs a setting with the necessary case numbers for analysis. A similar study referred to above had 164 cases for comparison in 2 groups with TUR-P and HoLEP for SSI occurrence, with SSI occurrence after HoLEP being 2/72 cases (2.8%) 9 . We therefore anticipate 180 cases (90 cases per arm) for a feasibility study with 95% CI for the future design of a prospective double blind non-inferiority study.…”

“…Many researchers suggest that inappropriate antibiotics use may cause this problem. Inappropriate antibiotic prescriptions are often seen, for instance in upper respiratory infections which is caused by not only bacteria but also virus 9 . Accordingly, the Japanese government suggested an AMR action plan aiming at a 50% decrease in the use of oral antibiotic such as cephalosporines or macrolides 10 .…”

A Preliminary, Multicenter, Prospective and Real World Study on the Hemostasis, Coagulation, and Safety of Hemocoagulase Bothrops Atrox in Patients Undergoing Transurethral Bipolar Plasmakinetic Prostatectomy

“…Surgery is widely used as an effective way to treat BPH. Surgical methods include open prostatectomy (Saluja et al, 2018), transurethral vaporization of the prostate (TUVP) (Littlejohn et al, 2004), TUPKP (He et al, 2016; Zeng et al, 2018a), and prostate laser surgery (Ketan and Prashant, 2016; Jhanwar et al, 2017).…”

Our clinic’s first experience with HoLEP

“…Woo MJ et al [23] compared results of TURP and HoLEP in 56 patients and six-month postoperative tests were in favor of HoLEP according to Qmax and post-void residual volume (PVR). In a study that distributed 144 patients into two equal homogeneous groups and compared TURP and HoLEP in >60 gr prostates, HoLEP was found advantageous regarding the amount of the resected tissue, amount of hemorrhage, development of hyponatremia, catheterization length, hospitalization length, and 12- and 24-month Qmax [24]. When both methods are evaluated according to long-term functional outcome, there are studies that show HoLEP has lower rates of urethral stenosis, independent of duration [25, 26].…”