Introduction: This was a prospective, randomized clinical
trial to compare the safety, effi cacy, and medium-term
durability of holmium laser enucleation of the prostate
(HoLEP) combined with mechanical morcellation versus
standard transurethral resection of the prostate (TURP)
for the surgical treatment of patients with bladder outlet
obstruction due to benign prostatic hyperplasia (BPH).
The patients had prostates that were greater than 30 g and
less than 100 g and were followed for 1 year.
Patients and methods: From April 2008 to December
2009, 80 consecutive patients with lower urinary tract
obstruction (LUTS) due to BPH were randomized to
either surgical treatment with HoLEP (group 1, n = 40)
or standard TURP (group 2, n = 40). Preoperative
assessments included American Urological Association
(AUA) symptom score, serum prostate-specifi c antigen
(PSA), post-voiding residual (PVR) urine volume,
transrectal ultrasound (TRUS), and urodynamic studies.
Perioperative parameters included total operating time,
resected tissue weight, hemoglobin loss, presence or
absence of blood transfusion, time of catheter removal,
and duration of hospital stay. Postoperative evaluations
were conducted at 1, 6, and 12 months.
Results: Patients in the HoLEP group had shorter
catheterization times and hospital stays than patients
in the TURP group. There was no signifi cant difference
in operating times between the two groups. Mean
hemoglobin loss was lower in the HoLEP group (1.8 ±
1.3 g/dL versus 2.9 ± 1.5 g/dL). There was a signifi cantly
greater improvement from baseline AUA symptom scores
and PVR urine volumes in the HoLEP group versus
the TURP group, at all postoperative assessments.
Postoperatively, 25% of patients in group 1 (HoLEP)
and 20% of patients in group 2 (TURP) had irritative
voiding symptoms. Urethral stricture occurred in three
cases (one case in the HoLEP group and two cases in the
TURP group).
Conclusion: HoLEP proved to be a safe and highly
effective technique for surgical treatment of bladder outlet
obstruction due to BPH.
Key Words: benign prostatic hyperplasia, HoLEP,
LUTS, TURP |
