Comparing the outcomes between holmium laser enucleation of the prostate, open prostate surgery and robotic prostate surgery for patients with large prostates.

This study compared the outcomes between holmium laser enucleation of the prostate (HOLEP), open simple prostate surgery (OSP), and robotic simple prostate surgery (RSP) in patients with benign prostate hypertrophy (BPH) and large prostates. The data showed that HoLEP was associated with a significantly shorter operative time, length of hospital stay, and catheter duration and lower estimated blood loss compared to OSP and RSP in these patients.

BPH is the non-cancerous increase in the size of the prostate gland. BPH can cause lower urinary tract symptoms (LUTS) such as frequent urination, trouble starting to urinate, and a weak stream while urinating. Other symptoms include urine leakage (incontinence) and discomfort passing urine. LUTS/BPH can lead to problems relating to the quality of life and mental health issues. Sexual function can also be impacted. Standard treatments for BPH involve surgical procedures and medications that can often affect ejaculation and sexual function.

Open simple prostate surgery (OSP) is a type of prostate surgery in which the prostate gland is removed by a surgeon by making small incisions. Robotic simple prostate surgery (RSP) is a type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo treatment with RSP commonly have less blood loss and shorter hospital stays. Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure to treat BPH. HoLEP allows for the destruction of prostate tissue with a laser inserted into the urethra (the opening in the penis). HoLEP is generally well-tolerated and associated with relatively few complications.

For patients with large prostate sizes (over 80 cc), treatment options like HoLEP, OSP, and RSP are recommended. However, a direct comparison of the outcomes of HoLEP versus OSP versus RSP for the treatment of patients with large prostates is lacking.

This study involved 340 patients who had a large prostate size (over 80 cc). 209 patients received treatment with HoLEP. 66 patients were treated with OSP. 65 patients were treated with RSP. Outcomes such as the length of stay at the hospital, operative time, catheter duration, estimated blood loss, blood transfusion, and 30-day emergency department visits and readmissions were compared between the three groups.

The operative time (duration of surgery) was significantly shorter with HoLEP treatment (1.4 hours) compared to OSP treatment (2.7 hours) and RSP treatment (3.8 hours).

The length of hospital stay was significantly shorter with HoLEP treatment (0.65 days) compared to OSP treatment (4.2 days) and RSP treatment (2.6 days).

The catheter duration (time until the removal of the urinary catheter) was significantly shorter with HoLEP treatment (0.38 days) compared to OSP treatment (9.9 days) and RSP treatment (11.2 days).

Estimated blood loss was significantly lower with HoLEP treatment (66 mL) compared to OSP treatment (795 mL) and RSP treatment (326 mL).

HoLEP and RSP were associated with a significantly lower risk of blood transfusion compared to OSP.

This study concluded that HoLEP was associated with a significantly shorter operative time, length of hospital stay, and catheter duration and lower estimated blood loss compared to OSP and RSP for the treatment of patients with BPH and large prostates.

This study looked back in time at medical records. The studies analyzed included patients treated at a single medical institution in the USA.