Urodynamic outcomes similar in those with large prostates; laser procedure removes more tissue
Holmium laser enucleation of the prostate (HoLEP) provides two-year outcomes equivalent to that of open prostatectomy in treating men with large prostates, according to two studies.
In one study, New Zealand investigators compared long-term outcomes from the two procedures in 60 patients with benign prostatic hyperplasia (BPH) whose prostates weighed 40-200 grams. Thirty patients were treated with HoLEP and 30 with transurethral resection of the prostate (TURP). The groups had similar preoperative characteristics. The mean preoperative transrectal ultrasound volume was 77.8 grams in the HoLEP group and 70.0 grams in the TURP arm.
A total of 48 patients reached the 24 month follow-up: 26 in the TURP group and 22 in the HoLEP group. The American Urological Association Symptom Score dropped from 26.0 at baseline to 6.1 at 24 months in HoLEP-treated patients and from 23.7 to 5.2 in the TURP patients, investigators reported in European Urology (2006;50:569-573). The maximum flow rate rose from 8.4 to 21 mL/sec in the HoLEP group and from 8.3 to 19.3 mL/sec in the TURP group. Quality of life scores improved from 4.8 to 1.25 in the HoLEP group and from 4.7 to 1.25 in the TURP group. None of the differences between the treatments was statistically significant.
TRUS prostate volume at six months was significantly less for the HoLEP-treated patients (28.4
vs. 46.6 grams). Two patients in the TURP arm, but none in the HoLEP arm, required re-operation. One TURP patient, but no HoLEP pa-tients, required a blood transfusion.
A previous study comparing HoLEP and TURP showed that the former was associated with shorter catheter times and hospital stay, although it took longer to perform.
The investigators concluded that HoLEP “represents a paradigm shift in the endoscopic management of BPH and can be used to treat prostates of all sizes. This study addresses the question of durability of HoLEP and suggests that it will be at least as durable as TURP in the long term as more tissue is surgically removed and by 24 months fewer re-operations were required.”
The authors stated “there is potentially no limit to the size of a prostate that can be treated with HoLEP.”
In the second study, also published in European Urology (2006;50:563-568), researchers in Italy compared HoLEP with open prostatectomy in 80 patients with prostates larger than 70 grams. Although operating time was shorter in the open prostatectomy group (39 patients), the HoLEP group (41 patients) had significantly shorter catheter times and hospital stays. HoLEP also was associated with less blood loss and fewer transfusions.
The two groups had similar baseline characteristics, including TRUS-determined prostate volumes: 113.27 grams in the HoLEP group and 124.21 grams in the open prostatectomy group. They also had similar peak flow rates, International Prostate Symptom Score (IPSS), and QOL score. At baseline, the HoLEP and prostatectomy groups had baseline peak flow rates of 7.83 and 8.32 mL/sec, respectively, an IPSS of 20.11 and 21.60, and QOL score of 4.07 and 4.44.
At 24 months after surgery, both groups had experienced similar changes in these parameters. The peak flow rates increased to 19.19 and 20.11 mL/sec in the HoLEP and prostatectomy patients, respectively; the IPSS decreased to 7.9 and 8.1 and QOL score fell to 1.5 and 1.66.
“HoLEP is a safe and minimally invasive technique for treatment of small and large prostates,” according to the researchers.