LBA01-05: Surgical Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Enlargement by Holmium Laser Enucleation of the Prostate versus Transurethral Resection of the Prostate and Open Adenomectomy

MIGUEL BELTRAN, YONI PALLAS , IVAN POVO, SARA MITJANA, KEVIN RECHI, MARTA DIRANZO, FERNANDO MARTINEZ, ROSA GRAS, EMILIO LOPEZ

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a novel technique for the treatment of lower urinary tract symptoms (LUTS) resulting from benign prostatic enlargement (BPE).  Current literature proposes that it can replace other techniques as a size-independent surgical treatment of BPE.

The aim of the study was to analyse the improvement in uroflowmetry (Qmax), hospitalization days, postoperative catheterisation, urinary incontinence and erectile dysfunction (ED) in patients treated with transurethral resection of the prostate (TURP) and HoLEP for prostates <90cc and in those treated with open adenomectomy and HoLEP for prostates >90cc.

Methods: 180 patients were enrolled in this prospective study from January 2020 to October 2021 in our centre. 38 and 51 patients underwent TURP and HoLEP respectively with prostate volume <90cc. 51 and 40 patients underwent open adenomectomy and HoLEP respectively with prostate volumes >90cc.

Results: In patients with prostate volumes >90cc, HoLEP achieved a mean improvement in Qmax at 6-12 months of 27.4 mL/s vs. 20.9 mL/s for adenomectomy (p=0.03), a mean hospital stay of 2.4 days vs. 4.6 days (p < 0.001) and a mean postoperative catheterization of 4.1 days vs. 10 days for adenomectomy (p < 0.001). During follow-up, ED was found in 4 patients (10%) in the HoLEP group and in 7 (13.7%) in the adenomectomy group.In patients with prostate volumes <90cc, HoLEP showed a mean improvement in Qmax at 6-12 months of 23.2 mL/s vs. 14.35 mL/s in the TURP group (p=0.001), a mean hospital stay of 1.71 days vs. 2 days (p=0.072) and a mean postoperative catheterization of 3.9 days vs. 3.97 days in the TURP group (p=0.83). As for the occurrence of ED during follow-up, it was found in 8 patients (15%) treated by HoLEP and in 3 patients (7.8%) treated by TURP.

Conclusions: HoLEP had a greater uroflowmetry improvement compared to open adenomectomy and TURP (p=0.03 and p=0.001 respectively). The mean hospital stay and postoperative catheterization days were reduced compared to open adenomectomy, but there were no differences in this aspect with TURP.

Source of Funding: No source of funding