EAU 2018: Challenging Large Sized Benign Prostate Hyperplasia - Randomized Trial of Bipolar Resection vs. Holmium Laser Enucleation vs. Greenlight Laser Vapo-Enucleation - Preliminary Report

Copenhagen, Denmark (UroToday.com) Dr. A. Elshal, clinical urologist from the Urology and Nephrology Center in Mansoura, Egypt, presented his findings on large sized benign prostatic hyperplasia (BPH), stating that this type of procedure has always been particularly challenging for urologists in minimally invasive surgery (MIS). Currently, the gold standard MIS procedure for treatment of BPH is holmium laser enucleation of the prostate (HoLEP). However, Dr. Elshal believes that two other surgical modalities may be efficacious in the treatment of large sized BPH: transurethral resection in saline (TURis) and Greenlight laser partial vapo-enucleation of the prostate (GL.PVEP). In this study, Dr. Elshal hopes to expand the knowledge of these techniques and to assess the non-inferiority of TURis and GL.PVEP to HoLEP. 

Patients for this study were recruited if prostate size was ≥ 80 mL, then were randomized to one of the three enucleation modalities. A total of 182 patients were recruited: 62 for GL.PVEP, 60 for HoLEP, and 60 for TURis. GL.PVEP was found to have a significantly longer operating time than HoLEP and TURis. TURis was shown to have a significantly longer median hospital stay, longer median time to catheter removal, and larger median hemoglobin-deficit than HoLEP and GL.PVEP. TURis also led to significantly greater perioperative complications such as capsular violation and anemia necessitating blood transfusion. International prostate symptom score (IPSS), prostate volume reduction (PVR), quality of line (QoL), and flow (Qmax) were not significant between the three groups. However, HoLEP had a significantly greater % PSA reduction than GL.PVEP and TURis. 

In closing, Dr. Elshal explained that the perioperative outcomes of GL.PVEP and HoLEP surpass TURis for the treatment of large sized prostate with a significantly longer operating time for GL.PVEP. Dr. Elshal went on to explain that all three techniques achieve good functional outcomes with comparable retreatment rates at one year. 

Presented by: Elshal A

Co-Authors: Soltan M. , El-Tabey N. , Laymon M. , Nabeeh H. , Nabeeh A
Author Information: Urology and Nephrology Center, Dept. of Urology, Mansoura, Egypt

Written by: Zachary Valley MD, (Department of Urology, University of California-Irvine) at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark