Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose?

Abstract

Background and purpose: Holmium enucleation of the prostate (HoLEP) has been established as an effective therapy for patients with benign prostatic hyperplasia (BPH), with less bleeding, shorter catheterization time, and shorter hospital stay. The evolution of the bipolar transurethral resection of the prostate (TURP) raised a question: Would it be able to provide all the advantages of HoLEP and compensate for all its drawbacks, including the higher costs and the steep learning curve?

Patients and methods: A randomized study was performed that compared HoLEP with bipolar TURP. The study included 60 patients with BPH who were randomized in two groups (1:1 fashion). The mean age, International Prostate Symptom Score, serum prostate-specific antigen value, maximum urinary flow rate, residual urine, prostate size, operative time, blood loss, resected volume, catheterization time, hospital stay, and intraoperative and postoperative complications were compared in both groups, with a follow-up period of 6 months postoperatively.

Results: Both techniques were comparable to each other. They shared the same advantages of decreased perioperative morbidity. The longer operative time in the HoLEP group, however, was still statistically significant. In addition, the expense of performing HoLEP was nearly double that of bipolar TURP.

Conclusion: HoLEP and bipolar TURP are effective in treating patients with lower urinary tract symptoms due to BPH, however; the long operative time, the steep learning curve, as well as the higher expenses of HoLEP are in favor of bipolar TURP.