Fewer Complications After Laser Enucleation of the Prostate

The odds of reoperation were significantly lower with laser enucleation of the prostate compared with laser vaporization and simple prostatectomy.

Laser enucleation of the prostate (LEP) results in the lowest odds of postoperative complications compared with other procedures for benign prostatic hyperplasia (BPH), according to real-world data presented at the AUA2021 Virtual Experience. However, LEP accounts for less than 5% of all BPH procedures performed in the US.

According to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2011 to 2017, a total of 35,130 men (59.0%) underwent an initial transurethral resection of the prostate (TURP), 3763 men (6.3%) underwent TURP for prostate regrowth, 16,085 men (27.0%) underwent laser vaporization (LVP), 2880 (4.8%) underwent LEP, and 1675 (2.8%) underwent simple prostatectomy (SP).

A multivariate logistic regression model showed that LEP was significantly associated with the lowest odds of postoperative urinary tract infection (UTI), Ahmed Elshabrawy, MD, Ahmed M. Mansour, MD, and colleagues from UT Health San Antonio in San Antonio, Texas, reported in a poster presentation. LVP and SP were both associated with 76% increased odds of UTI, and initial TURP and TURP for regrowth were associated with 55% and 35% increased odds of UTI, respectively.

SP was associated with significant 16.5-fold increased odds of blood transfusion compared with LEP, whereas LVP was significantly associated with 69% decreased odds of transfusion. With respect to reoperation, SP was significantly associated with 49% increased odds and LVP with 32% decreased odds compared with LEP.

Hospital readmission rates did not differ significantly among procedures.

“In a real-life setting, LEP was associated with superior outcomes in terms of rates of postoperative UTI, blood transfusion, and need for reoperation,” the investigators stated.

In an interview, Dr Mansour noted: “This study provides more evidence of the superiority of LEP. It also highlights the significant underutilization of LEP in the United States. I believe the main obstacle to greater use in the US is the perceived difficulty of the procedure and its steep learning curve.”

At AUA 2021, the team discussed a standardized approach for teaching HoLEP and adopting it in residency programs. Training is the key to increasing LEP use in the urologic community, Dr Mansour said.

Reference

Elshabrawy A, Wang H, Dursun F, Rowley K, Mansour AM. Perioperative outcomes after laser enucleation of the prostate: a comparative analysis using the national surgical quality improvement program database. Presented at: AUA2021 Virtual Experience heldSeptember 10-13, 2021. Abstract MP09-10.