Session: MP13: Benign Prostatic Hyperplasia: Surgical Therapy & New Technology I
MP13-14: Robot-Assisted Simple Prostatectomy versus Holmium Laser Enucleation for the Treatment of Benign Prostatic Hyperplasia in Large (>100 ml) Prostates: Updated Comparative Analysis from a High-Volume Center
Introduction: In patients with large benign prostatic hyperplasia (BPH), both Holmium Laser Enucleation of Prostate (HoLEP) and Robot-Assisted Simple Prostatectomy (RASP) are possible treatment options. While both techniques have advantages and disadvantages, comparative evidence on peri-operative outcomes of these operations for the treatment of large prostates (>100 ml) is still limited. Therefore, our aim was to update our comparative analysis of HoLEP vs. RASP for the treatment of BPH in patients with large (>100 ml) prostate volumes. Methods: We analyzed data of 339 patients with symptomatic BPH due to large (>100 ml) prostates glands who underwent RASP (n=130, 35%) and Holep (n=239, 65%) at OLV Hospital, Aalst (Belgium) between 2011 and 2021. We collected pre-operative baseline characteristics and peri-operative outcomes; peri-operative complications were reported according to the Clavien-Dindo classification. Functional parameters were assessed postoperatively 3 months after surgery. We compared pre-operative characteristics, operative time and peri- and post-operative outcomes between the groups. Results: Baseline characteristics – including age, BMI, preoperative IPSS score, preoperative maximum flow and post-voidal residue (PVR) – did not differ between patients receiving RASP vs. HoLEP (all p>0.05). As compared to HoLEP, patients treated with RASP had bigger prostates at preoperative imaging (median: 159 (115, 200) ml vs. 120 (110, 140) ml; p<0.001). Median operation time (100 min vs. 120 min), catheterization time (2 vs. 3 days) and length of stay (2 vs. 4 days) were slightly shorter in the HoLEP group (all p<0.001). On final pathology, median prostate weight was similar between the groups (100 gr vs. 105 gr; p=0.4). Complication rates were similar in both groups (rate of all Clavien-Dindo complications: 23% vs. 22%; p=0.2). At 3 months follow up, both groups showed an improvement of maximum flow rate (+12 vs. +13.3 ml/s; p=0.4), a reduction of PVR (-93 vs. -75 ml; p=0.9) and IPSS score (-16 vs. -12; p=0.2). Conclusions: Our study provided relevant data on peri-operative outcomes of RASP and Holep, and might help clinicians in preoperative counselling for men with large (>100 ml) prostates requiring surgery for BPH. While patients receiving RASP had slightly longer hospital stay, both techniques achieved excellent results in this patient population, and represent valuable treatment option according to physician preferences and expertise. SOURCE OF Funding: None
