Plasma Kinetic Enucleation vs Holmium Laser Enucleation for Treating Benign Prostatic Hyperplasia: A Randomized Controlled Trial with a 3-Year Follow-Up

Abstract

Purpose: To compare the efficacy and safety of plasma kinetic enucleation of the prostate (PKEP) with holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). Methods: A total of 160 patients with indications for the surgical treatment of BPH were randomly assigned to receive either PKEP or HoLEP prospectively. Baseline characteristics, perioperative data, and postoperative outcomes of the patients were recorded. One hundred twenty-six (78.75%) patients (PKEP 64 vs HoLEP 62) completed the 3-year follow-up assessment. Results: Patients in both groups had similar baseline characteristics. Compared with PKEP, HoLEP was associated with shorter operative time as well as take-out time, lower perioperative hemoglobin decrease, and shorter bladder irrigation time, catheterization time, and hospital stay time. PKEP was superior to HoLEP in terms of the noise of the machine and hospitalization expenses. There were no significant differences in enucleating time, resected weight, and serum sodium levels. Both groups achieved satisfactory results and maintained improvement from baseline in terms of maximum urinary flow rate (Qmax), International Prostatic Symptomatic Score, quality of life, and postvoid residual at 3-year follow-up, with no significant differences between the two procedures. Except for re-catheterization rate, postoperative data such as transrectal ultrasound volume, International Index of Erectile Function-5, and follow-up scores of the flexible cystourethroscopy results, as well as the acute and mid-to long-term complications after surgery, were statistically similar. Conclusion:The 3-year follow-up data of this randomized trial confirmed that both PKEP and HoLEP were effective and safe surgical procedures for the transurethral management of BPH. HoLEP presented certain advantages compared to PKEP, such as reduced operative duration, decreased risk of blood loss, and less bladder irrigation, hospital stay time, and re-catheterization rate, whereas PKEP had lower noise and no additional laser cost. Chinese Clinical Trial Registry (ChiCTR-TRC-13004468).

Complications and functional outcomes of endoscopic enucleation of the prostate: a systematic review and meta-analysis of randomised-controlled studies

“…Enucleation using plasma kinetic energy is an alternative option where laser facilities are not readily available. Most of the outcomes following PKEP are similar to enucleation using lasers, but may be superior due to lower cost and hospital expenses [ 20 ]. In addition, it achieves less blood loss and improved IPSS, QoL, and Qmax compared with TURP [ 33 ].…”

“…Appendix 2 summarises the study inclusion and exclusion criteria, and EEP characteristics. We performed meta-analyses when more than one RCT compared the same outcome: 1) HoLEP with ThuLEP [ 13 , 14 , 17 ]; 2) HoLEP with PKEP [ 18 , 19 , 20 ], and; 3) PKEP with DiLEP [ 21 , 22 ] ( Figure 2 ). Only one RCT compared HoLEP with GreenVEP [ 24 ], HoLEP with DiLEP [ 15 ] or, ThuLEP with PKEP [ 16 ], therefore, meta-analyses comparing these techniques were impossible, and we performed a descriptive analysis.…”

Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study

“…Nowdays, compared with the TURP, a well-known viewpoint is that the PKRP, HoLEP have comparable clinical outcomes in terms of maximum flow rate, postvoid residual urine, international prostate symptom score, and quality of life, the discrepancies often existed in their complications and surgical characteristics. [12–14]…”

“…Nowdays, compared with the TURP, a well-known viewpoint is that the PKRP, HoLEP have comparable clinical outcomes in terms of maximum flow rate, postvoid residual urine, international prostate symptom score, and quality of life, the discrepancies often existed in their complications and surgical characteristics. [12][13][14] Table 3 Distribution and grade of each complication among the 3 groups (n). For the comparison of surgical characteristics among the 3 groups, our results showed that many parameters in the PKEP group and HoLEP group were superior to those of the TURP group, and the decrease in hemoglobin and visual analogue scale after operation in the HoLEP group were obviously lower than those in the PKEP group.…”

A Novel Modified Two-Lobe Holmium Prostate Enucleation Technique: Demirtaş–Erciyes Enucleation Prostatectomy

“…On the other hand, the mean bladder irrigation time and mean time to catheter removal were reported as 19.56 and 78.45 hours, respectively, and the rate of retrograde ejaculation was reported as 37.10%. However, the enucleation technique used in the study was not specified [14]. Another recent study compared different enucleation techniques and reported that the enucleation time, morcellation time, and amount of tissue removed in the two-lobe technique were 50 minutes, 10 minutes, and 40 g, respectively [15].…”