Comparison of Holmium Laser Enucleation of the Prostate to Bipolar Plasmakinetic Enucleation of the Prostate: A Randomized Prospective Controlled Trial at Midterm Follow-up.

To compare the clinical efficacy and safety of holmium laser enucleation of the prostate (HoLEP) to bipolar plasmakinetic enucleation of the prostate (BPEP) in the surgical management of obstructive benign prostatic hyperplasia (BPH) at midterm (minimum 3 years) follow-up.

Between June 2016 and January 2018, one hundred and eighty-one patients who had bothersome lower urinary tract symptoms (LUTS) or were in refractory retention of urine due to obstructive BPH (prostate size 32-128gms) were randomized to undergo either HoLEP or BPEP by en-bloc technique. Patient's age, associated comorbidities, baseline IPSS, maximum flow rate (Qmax), post void residual (PVR) urine and quality of life (QoL) scores were comparable in both the groups. From each group, 86 patients who completed regular follow-up for 36 months were analyzed.

The mean pre-operative prostate volume was comparable in both the groups (HoLEP group-61.0928.25, BPEP group- 62.6627.37 grams). The HoLEP group showed a significantly better enucleation time (27.8713.18 Vs 38.3714.55 min), operative time (30.9114.82 Vs 41.6316.19 min) and enucleation efficiency (1.69 ± 0.28 Vs 1.28 ± 0.06 gm/min), with a lesser drop in hemoglobin (0.46 ± 0.23 Vs 0.87 ± 0.26 G/dL). Bladder irrigation time, catheterization time, hospital stay, and sodium drop were comparable in both the groups. One patient in BPEP group needed clot evacuation. Both groups showed a significant reduction in IPSS, improvement in Qmax, reduction in PVR and improved QoL scores at 3 months, that was maintained till 36-months. At three-year follow-up, two patients in each group needed reintervention for bladder neck contracture.

HoLEP and BPEP provide comparable safety and efficacy in the treatment of bladder outlet obstruction due to BPH at immediate and midterm (3-5 years) follow-up. HoLEP has an advantage of being faster with lesser peri-operative morbidity.

Journal of endourology. 2022 Aug 09 [Epub ahead of print]

Ajay Dattatray Bhandarkar, Dipen R Patel

Sujay Urological Hospital, 15, Vishwas Colony, Alkapuri, Baroda, India, 390005., Sujay Urological Hospital, Baroda, India; .

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