Minimally invasive laser surgery (HoLEP) as effective as conventional surgery for large BPH

This study compared robot-assisted open surgery and holmium laser enucleation of the prostate (HoLEP) for the treatment of large benign prostatic hyperplasia (BPH). Researchers reported similar results with robot-assisted prostate surgery and HoLEP in men with very large prostates.

BPH can lead to bothersome urinary symptoms that can affect quality of life. Although surgical treatments for BPH have become less invasive over the past years, very large prostates often still require open surgery. Robot-assisted open prostate surgery is often the preferred method to reduce the risk of complications.

A minimally invasive procedure, holmium laser enucleation of the prostate (HoLEP), has been the focus of investigation as a possible alternative. HoLEP allows for the destruction of prostate tissue with a laser inserted into the urethra (the penile opening). Compared to conventional prostate surgery, this method is associated with fewer complications and faster recovery. More studies are needed to demonstrate the safety and effects of HoLEP in patients with very large prostates.

The aim of this study was to directly compare robot-assisted prostate surgery and HoLEP in men with large BPH.

126 men with BPH and prostates larger than 100 ml were included in the study. 81 men underwent robot-assisted open surgery. 45 men underwent HoLEP. Treatment outcomes were compared and followed for an average of 5 to 12 months.

No significant differences in effectiveness were observed between the two procedures. Urinary symptoms, urine flow rate, and complete bladder emptying were all similarly improved. None of the patients developed a recurrence of urinary symptoms at follow-up.

Operating time was similar between the two procedures (average 105 minutes), as was blood loss during surgery. The amount of prostate tissue removed favored robot-assisted prostate surgery (112 g) when compared to HoLEP (89 g). However, catheterization time (flexible tube inserted into the bladder to drain urine) and length of hospital stay were significantly reduced with HoLEP.

No significant differences were noted between the two procedures regarding long-term side effects. Robot-assisted prostate surgery was most commonly associated with side effects related to bowel function and surgical wound. Temporary urinary incontinence (lasting less than 6 months) was more frequent in patients receiving HoLEP. No serious side effects were observed.

Researchers concluded that robot-assisted prostate surgery and HoLEP can achieve similar improvements in men with large prostates.

Larger studies that randomly assign patients to treatment groups are needed to confirm these results.