Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

Abstract

Objective To compare transurethral resection in saline (TURIS), Greenlight laser vapo‐enucleation of the prostate (GL.PVEP), and holmium laser enucleation of the prostate (HoLEP), for controlling lower urinary tract symptoms secondary to large benign prostatic hyperplasia (BPH) and to assess non‐inferiority of 3‐year re‐treatment rates. Patients and Methods Eligible patients with BPH (prostate size 80–150 mL) were randomly assigned to one of the intervention groups. Non‐inferiority of re‐treatment rate was evaluated using a one‐sided test at 5% level of significance. Results At the time of analysis, 60 GL.PVEP, 60 HoLEP and 62 TURIS procedures were included. Perioperative parameters were comparable between groups; however, the operative time was longer in GL.PVEP vs HoLEP and TURIS, at a mean (SD) of 92 (32) vs 73 (30) and 83 (28) min (P = 0.005); and was less effective with a mean (SD) removal of 1.2 (0.4) vs 1.7 (0.7) and 1.4 (0.6) g/min (P < 0.001), respectively. Perioperative complications and need for auxiliary procedures were similar in the three groups; however, there was a significantly higher rate of capsular perforation in TURIS group (five, 8%) compared to one (1.6%) in the GL.PVEP group and none in the HoLEP group (P = 0.01). There was a significantly longer hospital stay, catheter‐time and higher rate of blood transfusion in the TURIS group. There was significant but comparable improvements in the International Prostate Symptom Score in three groups at different follow‐up points. At 3 years, re‐treatment for recurrent bladder outlet obstruction was required more after GL.PVEP and TURIS. More re‐do surgeries for recurrent obstructing prostate adenoma was reported after GL.PVEP (four, 6.7%) and TURIS (six, 9.7%) than for HoLEP (none) (P = 0.04). Conclusion The perioperative outcomes of GL.PVEP and HoLEP surpassed that of TURIS for the treatment of large prostates, but with a significantly prolonged operative time with GL.PVEP. The three techniques achieve good functional outcomes; however, 3‐year re‐treatment rates following TURIS and GL.PVEP were inferior to HoLEP.

Holmium laser enucleation versus bipolar resection in the management of large‐volume benign prostatic hyperplasia: A randomized controlled trial

“…RCTs comparing HoLEP with B-TURP for large-volume prostates (>80 cc) are scarce. 2,3 We found that both techniques were effective, with significant improvements in IPSS, Q max , PVRU and QoL up to the last follow-up (36 months). However, HoLEP led to significantly better improvement in Q max and IPSS compared to B-TURP.…”

“…This was similar to results reported in other RCTs comparing HoLEP versus B-TURP for large-volume prostates (Table 6). 2,3 Furthermore, we reported a higher percentage of removed prostate tissue in relation to preoperative prostate (TRUS) volume with HoLEP (79%) compared to B-TURP (60%). This finding was similar to that reported in a previous retrospective comparative study (HoLEP; 63.5% vs B-TURP; 49.5%).…”

“…These results were similar to those reported by Habib et al 2 after 24 months of follow-up, with significantly better IPSS decreases and percentages of improvement for both IPSS and QoL with HoLEP. Similarly, Elshal et al 3 reported significantly better Q max with HoLEP 3 years postoperatively, but found no significant difference in IPSS. As the duration of follow-up increases (long term), the difference between the techniques tends to become more significant.…”

“…1 Furthermore, the guidelines state that high-level evidence for larger prostates (>80 cc) is limited to only a few RCTs, 1 while there are even fewer RCTs directly comparing HoLEP with B-TURP for large prostates. 2,3 Although HoLEP is a standard treatment for the management of large prostate glands, it requires experience and skills, and is also expensive. This may limit the widespread use of HoLEP and other enucleation techniques.…”

Immediate Transurethral Plasma Kinetic Enucleation of the Prostate Gland for Treatment of Benign Prostatic Hyperplasia-Associated Massive Hemorrhage: A Single-Center Experience

“…In general, BMH indicates a need for surgical intervention. However, most patients with BPH patients are elderly and likely to have one or more diseases, so the risks of surgery and anesthesia increase exponentially ( 5 , 8 ). Transurethral resection of the prostate gland (TURP) is a minimally invasive method to treat BMH.…”