Holmium Laser Enucleation of the prostate versus monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Abstract

All the patients were assessed preoperatively and followed at 1 and 12 months postoperatively. The primary preoperative and postoperative parameters were IPSS (the international prostate symptom score), maximum urine flow rate (Q-max), while the secondary parameters were operative time, resected volume, post-operative drop in hemoglobin level, post-operative change in sodium level, post-operative catheterization time, duration of hospital stay, post voiding residual urine (PVRU) and ultrasound assessed prostate volume. All complications were recorded. Cost analysis was evaluated. 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study with follow up period of 12 months. Mean baseline prostate sizes were similar in both groups, 63.9 in HoLEP versus 62.6 in TURP group. HoLEP group was associated with longer operative time of 80 minutes compared to 60 minutes in the TURP group (P value<0.001). HoLEP was associated with shorter postoperative catheter time and hospital stay compared to those of TURP group. There were no statistically significant difference between both groups as regards perioperative parameters as resected volume, haemoglobin drop, sodium level drop. Also postoperative IPSS, Qmax, PVRU, PSA and quality of life (QoL) were comparable in both groups. On the other hand, there was a statistically significant difference in each group in comparison to its preoperative baseline parameters. There was no statistically significant difference between the two groups as regards postoperative complications. Urinary tract infection (UTI) happened in 10% and 13.3% of patients in HoLEP and TURP groups respectively (P value 0.69). In each group 2 cases of bladder neck contracture were reported that required an endoscopic resection. 10% of patients of HoLEP group and 13.3% of patients in TURP group showed early SUI, they showed improvement on pelvic floor exercises at the end of our study where only 3.3% of cases in HoLEP group and 6.7% of cases in TURP group showed no improvement with no statistically significant difference (P value 0.55). As regards cost analysis HoLEP was more cost effective than TURP. Consequently, we have concluded that both HoLEP and monopolar TURP are safe and effective in the surgical management of benign prostatic hyperplasia. However, HoLEP has shorter catheterization time and hospital stay and more cost effectiveness but longer operative time than monopolar TURP.