To compare outcomes between endoscopic enucleation of the prostate with Thulium: YAG laser (ThuLEP) and robot-assisted simple prostatectomy (RASP) in the treatment of prostates ≥ 150 ml.
Patients with benign prostatic obstruction and prostate volume ≥ 150 ml underwent ThuLEP (Group A) versus transvesical RASP (Group B). Operative time, length of stay, catheterization time, haemoglobin drop were recorded. Functional outcomes were evaluated through the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual (PVR). Complications rate was compared.
200 patients were treated, 100 for each group with comparable preoperative features. Mean prostate volume was 178.6 ml in Group A vs. 186.3 ml in Group B (p = 0.11). Mean total operative time was 82.7 vs. 66.3 min (p = 0.04), catheterization time 3.5 vs. 7.3 days (p = 0.05), length of stay 2.5 vs. 4.8 days (p = 0.04), haemoglobin drop 0.7 vs. 1.3 g/dl (p = 0.06) after ThuLEP vs. RASP. No differences were observed in mean IPSS, Qmax and PVR. Higher rates of urinary infections (4.0% vs. 8.0%, p = 0.05) and urinary retention (4.0% vs. 9.0%, p = 0.04) occurred after RASP. Higher rates of temporary urgency (12.0% vs. 4.0%, p = 0.03) and urge incontinence (3.0% vs. 0%, p = 0.04) were observed after ThuLEP, with no differences in stress incontinence.
ThuLEP and RASP in expert hands are equally effective to treat very large prostates (≥ 150 ml) with no significant differences in micturition improvements. Operative time is shorter with RASP. Complication profile is different between the two procedures with no differences in major adverse events.
World journal of urology. 2025 Dec 08*** epublish ***
Davide Perri, Giovannalberto Pini, Umberto Besana, Giovanni Balocchi, Javier Romero-Otero, Jean-Baptiste Roche, Antonio Luigi Pastore, Lukas Lusuardi, Maria Chiara Sighinolfi, Bernardo Rocco, Giorgio Bozzini
Department of Urology, Division of Urology, Azienda Socio Sanitaria Territoriale Lariana, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Como, Italy. ., Department of Urology, Division of Urology, Azienda Socio Sanitaria Territoriale Lariana, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Como, Italy., Department of Urology, ROC Clinic and HM Hospitales, Madrid, Spain., Department of Urology, Clinique Saint Augustin, Bordeaux, France., Department of Urology, Sapienza University, Rome, Italy., Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria., Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41361597