Comparison of the efficacy of HoLEP and TURP in the treatment of elderly benign prostatic hyperplasia patients: a retrospective study

Abstract

Objective To prove that holmium laser prostatectomy (HoLEP) is safe and effective in the treatment of benign prostatic hyperplasia (BPH), and is superior to transurethral prostatectomy (TURP) for elderly patients.

Methods We retrospectively studied 565 HoLEP patients and 76 TURP elderly patients. HoLEP patients were first divided into three groups according to their age(Under 65 years old group, 65–79 years old group and over 80 years old group), and their preoperative, intraoperative, and postoperative characteristics were then compared. Secondly, the same characteristics of HoLEP and TURP patients over 80 years were compared. Chi-square test, one-way ANOVA and Fisher’s exact test were used in this study.

Results Firstly, we compared HoLEP patients in different age groups and found that there was statistically significant difference in diabetes, CCVD and bladder stones, among the three groups (P<0.05).

Secondlye, we compared HoLEP and TURP treatments in elderly patients (≥80 years old). The patients with HoLEP had a higher share of diabetes, CCVD and anticoagulation (P<0.05). Moreover, compared with TURP patients, HoLEP patients had shorter enucleation duration, more enucleate prostate weight, fewer hemoglobin diminutions, shorter bladder irrigation time, shorter catheter-indwelling period, and shorter hospital period (P<0.05). Although there was no difference in IPSS, Qmax and QOL between the two groups before operation (P>0.05), the difference was statistically significant, 6 months after the operation (P<0.05).

Conclusion HoLEP is safe and effective for BPH patients, and is superior to transurethral TURP for elderly patients.

Zusammenfassung

Zielsetzung Es sollte nachgewiesen werden, dass die Holmium-Laser-Prostatektomie (HoLEP) bei der Behandlung der benignen Prostatahyperplasie (BPH) sicher und wirksam ist und der transurethralen Prostatektomie (TURP) bei älteren Patienten überlegen ist.

Methoden Wir haben retrospektiv 565 HoLEP-Patienten und 76 ältere TURP-Patienten untersucht. Die HoLEP-Patienten wurden zunächst nach ihrem Alter in drei Gruppen eingeteilt (die Gruppe der unter 65-Jährigen, die Gruppe der 65–79-Jährigen und die Gruppe der über 80-Jährigen), und dann wurden ihre präoperativen, intraoperativen und postoperativen Merkmale verglichen. Zweitens wurden die gleichen Merkmale von HoLEP- und TURP-Patienten über 80 Jahren verglichen. In dieser Studie wurden der Chi-Quadrat-Test, die einseitige ANOVA und der exakte Test von Fisher verwendet.

Ergebnisse Erstens verglichen wir HoLEP-Patienten in verschiedenen Altersgruppen und stellten fest, dass es einen statistisch signifikanten Unterschied bei Diabetes, CCVD und Blasensteinen zwischen den 3 Gruppen gab (P<0,05).

Zweitens verglichen wir HoLEP- und TURP-Behandlungen bei älteren Patienten (≥80 Jahre alt). Die Patienten mit HoLEP hatten einen höheren Anteil an Diabetes, CCVD und Antikoagulation (P<0,05). Außerdem hatten HoLEP-Patienten im Vergleich zu TURP-Patienten eine kürzere Enukleationsdauer, ein höheres Gewicht der enukleierten Prostata, eine geringere Hämoglobinverminderung, eine kürzere Blasenspülungszeit, eine kürzere Katheterverweildauer und einen kürzeren Krankenhausaufenthalt (P<0,05). Obwohl es vor der Operation keinen Unterschied in IPSS, Qmax und Lebensqualität zwischen den beiden Gruppen gab (P>0,05), war der Unterschied 6 Monate nach der Operation statistisch signifikant (P<0,05).

Schlussfolgerung Die HoLEP ist bei BPH-Patienten sicher und wirksam und der transurethralen TURP bei älteren Patienten überlegen.

Keywords

BPH - HoLEP - TURP

Schlüsselwörter

Prostatahyperplasie - Transurethraler Holmium Laser Enukleation der Prostata - Transurethrale Prostatektomie

Publication History

Received: 08 September 2023

Accepted after revision: 02 November 2023

Article published online:
23 January 2024

• Reference

• 1 Bartsch G, Rittmaster RS, Klocker H. Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia. Eur Urol 2000; 37: 367-380 DOI: 10.1007/s00345-002-0248-5. (PMID: 12022710)
• 2 Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am 2016; 43: 289-297 DOI: 10.1016/j.ucl.2016.04.001. (PMID: 27476122)
• 3 Gratzke C, Bachmann A, Descazeaud A. et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015; 67: 1099-1109 DOI: 10.1016/j.eururo.2014.12.038. (PMID: 25613154)
• 4 Malaeb BS, Yu X, McBean AM. et al. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000–2008). Urology 2012; 79: 1111-1116 DOI: 10.1016/j.urology.2011.11.084. (PMID: 22546389)
• 5 Lourenco T, Pickard R, Vale L. et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials. BMJ 2008; 337: a1662 DOI: 10.1136/bmj.a1662. (PMID: 18845591)
• 6 Wendt-Nordahl G, Bucher B, Häcker A. et al. Improvement in mortality and morbidity in transurethral resection of the prostate over 17 years in a single center. J Endourol 2007; 21: 1081-1087 DOI: 10.1089/end.2006.0370. (PMID: 17941791)
• 7 Shvero A, Calio B, Humphreys MR. et al. HoLEP: the new gold standard for surgical treatment of benign prostatic hyperplasia. Can J Urol 2021; 28 (Suppl. 02) 6-10 (PMID: 34453422)
• 8 Jiawei C, Bo H, Wei D. Meta-analysis of efficacy and safety of holmium laser enucleation of the prostate and transurethral resection of the prostate in treatment of benign prostatic hyperplasia. J Clin Urology (China) 2021; 36: 431-438
• 9 Tamalunas A, Westhofen T, Schott M. et al. The clinical value of holmium laser enucleation of the prostate in octogenarians. Low Urin Tract Symptoms 2021; 13: 279-285 DOI: 10.1111/luts.12366. (PMID: 33260275)
• 10 Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998; 33: 69-72 DOI: 10.1159/000019535. (PMID: 9471043)
• 11 Jian H, Jianye W, Chuize K. Guideline for Urology and Andrology Diseases Diagnosis and Treatment in China. Beijing: Science Press; 2019
• 12 Patel A, Nunez R, Mmeje CO. et al. Safety and feasibility of concomitant surgery during holmium laser enucleation of the prostate (HoLEP). World J Urol 2014; 32: 1543-1549
• 13 Woo MJ, Ha YS, Lee JN. et al. Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity. Int Neurourol J 2017; 21: 46-52
• 14 Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 2008; 53: 160-166 DOI: 10.1016/j.eururo.2007.08.036. (PMID: 17869409)
• 15 Ahyai SA, Chun FK, Lehrich K. et al. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy – which procedure is faster?. J Urol 2012; 187: 1608-1613
• 16 Vavassori I, Valenti S, Naspro R. et al. Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol 2008; 53: 599-604
• 17 Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: a size-independent new "gold standard". Urology 2005; 66 (Suppl. 05) 108-113 DOI: 10.1016/j.urology.2005.06.006. (PMID: 16194716)
• 18 Mmeje CO, Nunez-Nateras R, Warner JN. et al. Age-stratified outcomes of holmium laser enucleation of the prostate. BJU Int 2013; 112: 982-989 DOI: 10.1111/bju.12063. (PMID: 23510326)
• 19 Anan G, Kaiho Y, Iwamura H. et al. Anteroposterior dissection three-lobe technique: an effective surgical method for inexperienced surgeons performing holmium laser enucleation of the prostate. Int Urol Nephrol 2020; 52: 1821-1828 DOI: 10.1007/s11255-020-02493-z. (PMID: 32409975)
• 20 Magistro G, Schott M, Keller P. et al. Enucleation vs. Resection: A Matched-pair Analysis of TURP, HoLEP and Bipolar TUEP in Medium-sized Prostates. Urology 2021; 154: 221-226 DOI: 10.1016/j.urology.2021.04.004. (PMID: 33891930)
• 21 Matani Y, Mottrie AM, Stöckle M. et al. Transurethral prostatectomy: a long-term follow-up study of 166 patients over 80 years of age. Eur Urol 1996; 30: 414-417 DOI: 10.1159/000474208. (PMID: 8977060)
• 22 Shah HN, Mahajan AP, Hegde SS. et al. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int 2007; 100: 94-101 DOI: 10.1111/j.1464-410X.2007.06867.x. (PMID: 17419697)
• 23 Vavassori I, Valenti S, Naspro R. et al. Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol 2008; 53: 599-604
• 24 Tan AH, Gilling PJ, Kennett KM. et al. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 2003; 170: 1270-1274
• 25 Montorsi F, Naspro R, Salonia A. et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2004; 172: 1926-1929
• 26 Ahyai SA, Gilling P, Kaplan SA. et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 2010; 58: 384-397