Holmium laser enucleation versus transurethral resection of the prostate.

INTRODUCTION This was a prospective, randomized clinical trial to compare the safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation versus standard transurethral resection of the prostate (TURP) for the surgical treatment of patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH). The patients had prostates that were greater than 30 g and less than 100 g and were followed for 1 year. PATIENTS AND METHODS From April 2008 to December 2009, 80 consecutive patients with lower urinary tract obstruction (LUTS) due to BPH were randomized to either surgical treatment with HoLEP (group 1, n = 40) or standard TURP (group 2, n = 40). Preoperative assessments included American Urological Association (AUA) symptom score, serum prostate-specific antigen (PSA), post-voiding residual (PVR) urine volume, transrectal ultrasound (TRUS), and urodynamic studies. Perioperative parameters included total operating time, resected tissue weight, hemoglobin loss, presence or absence of blood transfusion, time of catheter removal, and duration of hospital stay. Postoperative evaluations were conducted at 1, 6, and 12 months. RESULTS Patients in the HoLEP group had shorter catheterization times and hospital stays than patients in the TURP group. There was no significant difference in operating times between the two groups. Mean hemoglobin loss was lower in the HoLEP group (1.8 ± 1.3 g/dL versus 2.9 ± 1.5 g/dL). There was a significantly greater improvement from baseline AUA symptom scores and PVR urine volumes in the HoLEP group versus the TURP group, at all postoperative assessments. Postoperatively, 25% of patients in group 1 (HoLEP) and 20% of patients in group 2 (TURP) had irritative voiding symptoms. Urethral stricture occurred in three cases (one case in the HoLEP group and two cases in the TURP group). CONCLUSION HoLEP proved to be a safe and highly effective technique for surgical treatment of bladder outlet obstruction due to BPH.