Comparing enucleation and resection for BPH in medium-sized prostates

This study compared the effectiveness and safety of holmium laser enucleation of the prostate (HoLEP), bipolar transurethral enucleation of the prostate (bTUEP), and transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH) in medium-sized prostates. The authors concluded that all techniques are effective, but both HoLEP and bTUEP have better complication rated compared to TURP.

Lower urinary tract symptoms (LUTS) occur in patients with BPH. BPH is a prostate enlargement, which results in the obstruction of urine flow. It affects the quality of life for patients. The standard treatment of BPH is TURP. This involves cutting away parts of the prostate through a tube inserted through the penis. While effective, TURP is associated with side effects such as erectile dysfunction, urine leakage (incontinence), and urinary infections. Alternative, less invasive approaches, are therefore being evaluated.

Enucleation techniques such as HoLEP and bTUEP are minimally invasive alternatives to TURP. Enucleation involves the removal of only the excess prostate tissue blocking urine flow. HoLEP involves a laser to cut away the extra prostate tissue. bTUEP involves an electrical current used to remove extra prostate tissue. 

There is a need to compare the effectiveness and safety of HoLEP and bTUEP techniques to TURP in men with medium-sized prostates.

This study analyzed data from 261 men with LUTS from BPH. 87 patients were each treated by HoLEP, bTUEP and TURP. Patients had medium-sized prostates of around 50 ccs. Patients were followed up 4 weeks after surgery.

The surgical times of HoLEP and bTUEP were 51 minutes and 50 minutes compared to 60 minutes for TURP. More prostate tissue was removed using HoLEP (71.4%) and bTUEP (70%) compared to TURP (50%). There was no difference in blood loss, hospital stay, and time with a catheter (tube inside the penis to urinate) between groups. 

There was a higher urine flow and lower urine residual volume in the HoLEP and bTUEP groups compared to the TURP group. Larger improvements in urinary symptoms and quality of life were seen in the enucleation groups compared to TURP. 

This study concluded that resection and enucleation techniques are effective and safe in patients with medium-sized prostates experiencing LUTS, due to BPH. However, enucleation techniques provided better functional outcomes to these patients. 

This study was based on medical records. Information might have been missing. Further randomized studies are needed for better conclusions.