Benign Prostatic HyperplasiaHolmium Laser Enucleation versus Transurethral Resection of the Prostate: 3-Year Follow-Up Results of a Randomized Clinical Trial
Introduction
Transurethral resection of the prostate (TURP) is considered the gold standard of surgical treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE) [1], [2], [3]. However, TURP is limited to prostates weighing less than 80–100 g and is associated with significant morbidity [1], [2], [3], [4]. Therefore, a demand for less-invasive treatment modalities exists. During the last decade, several so-called minimal-invasive procedures emerged as less invasive than TURP. However, it became evident that, in these alternative techniques, the morbidity was shifted from the intraoperative towards the postoperative period [5]. None of these minimal-invasive procedures could compete with TURP in terms of durability of results and low reoperation rates. Advances in laser technology have led to the development of holmium laser enucleation of the prostate (HoLEP), and its genuine potential has now been broadly recognised. Short-term outcome data of several randomised clinical trials have proved that HoLEP was at least equally effective and less invasive than TURP [6], [7], [8]. However, randomised medium-term and long-term studies are rare [9]. Westenberg and coworkers [10] reported on a minimum of 4-yr follow-up results from a randomised trial comparing TURP with holmium laser resection of the prostate, which is similar to but has been replaced by HoLEP. Follow-up results comparing HoLEP with TURP of longer than 2 yr do not yet exist. We report the 2-yr and 3-yr follow-up results of our previously published randomised trial comparing HoLEP with TURP [6].
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Patients
The study was performed at the Urology Department, Auguste-Viktoria-Hospital, Berlin. Patients and methods have been previously reported in detail [6]. In summary, 200 patients were randomised to either HoLEP or TURP with a schedule balanced in blocks of four, after ethical approval and written consent of the patients were obtained. Inclusion criteria were American Urological Association Symptom Score (AUA SS) of 12 or more, Qmax of 12 ml/s or less, PVR volume of 50 ml or more, Schäfer grade of
Baseline characteristics
As shown in Table 1, there were no statistically significant differences in baseline characteristics between the two groups.
Perioperative results
Perioperative results were previously reported in detail [6].
Micturition parameters
Follow-up data of the two groups (1 mo to 3 yr postoperatively) are presented in Table 2. Both therapy modalities resulted in statistically significant improvements of AUA SS, Qmax, and PVR volume at each postoperative assessment compared with baseline values. In the HoLEP group, the AUA SS were significantly
Discussion
When the first high-powered holmium lasers became available on the market, a new technology could be used for incision, ablation, resection, and, more recently, enucleation of the human prostate in a relatively bloodless manner. HoLEP appeared to be a promising alternative to TURP to acutely remove obstructing prostatic tissue. We, therefore, started a randomised clinical trial, comparing HoLEP with TURP [6]. The perioperative results clearly favored the HoLEP procedure. HoLEP patients had
Conclusions
After 3 yr of follow-up, HoLEP micturition outcomes compare favourably with TURP. Late complications are equally low. HoLEP may be a real alternative to TURP.
Conflicts of interest
On behalf of the authors, we deny any commercial relationship such as stock ownership or other equity interests, patents received and/or pending, or any commercial relationship that might be in any way considered related to the submitted article.
Professor Kuntz is a consultant for the companies Lumenis and Karl Storz.
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