Introduction

Simple prostatectomy is the standard surgical treatment for benign prostatic hypertrophy (BPH) in men with large prostates. There are increasing efforts to treat BPH with minimally invasive techniques including holmium laser enucleation of the prostate (HoLEP) and robotic assisted simple prostatectomy (RSP). Herein we compare perioperative outcomes for patients undergoing one of these two procedures.

Methods

Patient demographics and perioperative outcomes were compared between 600 patients undergoing HoLEP and 32 patients undergoing RSP at two separate academic institutions between 2008 and 2015.

Results

Patients undergoing HoLEP and RSP had comparable ages (71 vs. 71, p=0.96) and baseline AUA symptom scores (20 vs. 24, p= 0.21). There was no difference in mean specimen weight (96 vs. 110 g, p=0.15). Mean operative time was reduced in the HoLEP cohort (103 vs. 274 minutes, p<0.001). Patients undergoing HoLEP had lesser decreases in hemoglobin, decreased transfusions rates, shorter hospital stays, and decreased mean duration of catheterization. There was no difference in the rate of complications Clavien grade 3 or greater (p=0.33).

Conclusions

HoLEP and RSP are both efficacious treatments for large gland BPH. In expert hands HoLEP appears to have a favorable perioperative profile. Further studies are necessary to compare long-term efficacy, cost, and learning curve influences, especially as minimally invasive approaches become more widespread.

Funding

None