Benign prostatic hyperplasia (BPH) is a prevalent condition in ageing men, often resulting in significant lower urinary tract symptoms (LUTS) that impact quality of life. For patients with huge prostate volumes (>150 mL), surgical management presents challenges. Traditionally, open simple prostatectomy (OSP) was the gold standard; however, minimally invasive approaches such as robotic-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP), especially holmium laser enucleation of the prostate (HoLEP), offer similar or superior outcomes with reduced morbidity.
This review analyzed studies comparing the perioperative, functional, and complication outcomes of RASP and HoLEP in treating very large prostates (>150 mL). A comprehensive literature search was performed to evaluate evidence on surgical efficacy, complication rates, and recovery profiles.
Both RASP and HoLEP demonstrated excellent perioperative outcomes, with HoLEP providing reduced operative time and hospital stays. HoLEP also showed lower blood loss and a reduced need for transfusions, while RASP offered advantages in terms of precision and surgeon control, especially for anatomically complex cases. Functional outcomes, including improvement in urinary flow and symptom scores, were comparable between the two techniques. However, complications such as transient incontinence were more commonly reported with HoLEP.
Both RASP and HoLEP are effective and safe for the management of very large prostates. HoLEP offers significant advantages in perioperative recovery and reduced morbidity, whereas RASP provides excellent outcomes in complex cases requiring precise dissection. The choice between these techniques should be guided by patient-specific factors and surgical expertise. Future studies should focus on long-term functional outcomes to refine surgical recommendations further.
The French journal of urology. 2025 Mar 13 [Epub ahead of print]
Ugo Pinar, Clément Sarrazin, Julien Anract, Armand Chevrot, Hakim Fassi-Fehri, Jonas Wilisch, Jérôme Gas, Yohann Rouscoff, Emmanuel Dellanegra, Clément Klein, Hervé Baumert, Steeve Doizi, Souhil Lebdai
Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Department of Urology, F-75013 Paris, France. Electronic address: ., Department of Urology, Grenoble Alpes University Hospital, Grenoble, France., Division of Urology, Cochin Hospital, APHP, Paris Cité University, Paris, France., Clinique Rhone-durance, Avignon, France., Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France., Service d'urologie, Hôpital Privé Natecia, Lyon, France., Uropole Montauban, France., Polyclinique Saint Georges, Nice, France., Service d'urologie, Hôpital des Côtes d'Armor, Saint Brieuc, France., Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France., Department of Urology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France., Hôpital universitaire Tenon, Paris, France., Service d'urologie, CHU Angers, Angers, France.