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Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database

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Abstract

Purpose

To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates.

Results

The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47–0.58) times the odds of a LOS > 1 day and 0.67 (0.54–0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR.

Conclusion

Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.

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Notes

  1. Partially dependent patients require assistance from another person for activities of daily activities. This category also includes those relying on prosthetics and devices. Totally dependent patients require total assistance for all activities.

References

  1. Lukacs B, Cornu JN, Aout M, Tessier N, Hodee C, Haab F, Cussenot O, Merliere Y, Moysan V, Vicaut E (2013) Management of lower urinary tract symptoms related to benign prostatic hyperplasia in real-life practice in France: a comprehensive population study. Eur Urol 64(3):493–501

    Article  PubMed  Google Scholar 

  2. Wei JT, Calhoun E, Jacobsen SJ (2005) Urologic diseases in America project: benign prostatic hyperplasia. J Urol 173(4):1256–1261

    Article  PubMed  Google Scholar 

  3. Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, Ugurlu M, Muslumanoglu A (2013) Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int 111(1):129–136

    Article  PubMed  Google Scholar 

  4. Kahokehr A, Gilling PJ (2014) Enucleation techniques for benign prostate obstruction: which one and why? Curr Opin Urol 24(1):49–55

    Article  PubMed  Google Scholar 

  5. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096

    Article  PubMed  Google Scholar 

  6. Roberts WW (2016) New technologies in benign prostatic hyperplasia management. Curr Opin Urol 26(3):254–258

    Article  PubMed  Google Scholar 

  7. Rivera M, Krambeck A, Lingeman J (2017) Holmium laser enucleation of the prostate in patients requiring anticoagulation. Curr Urol Rep 18(10):77

    Article  PubMed  Google Scholar 

  8. Yin L, Teng J, Huang CJ, Zhang X, Xu D (2013) Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 27(5):604–611

    Article  PubMed  Google Scholar 

  9. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411

    Article  PubMed  Google Scholar 

  10. Wu WC, Schifftner TL, Henderson WG, Eaton CB, Poses RM, Uttley G, Sharma SC, Vezeridis M, Khuri SF, Friedmann PD (2007) Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 297(22):2481–2488

    Article  CAS  PubMed  Google Scholar 

  11. Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK (2011) Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 212(2):187–194

    Article  PubMed  Google Scholar 

  12. Madduri VKS, Bera MK, Pal DK (2016) Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario. Urol Ann 8(3):291–296

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lerner LB, Rajender A (2015) Laser prostate enucleation techniques. Can J Urol 22(Suppl 1):53–59

    PubMed  Google Scholar 

  14. NSQIP A (2013) Variables and definitions. In: ACS NSQIP Operations Manual. pdf edn. 1–139

  15. Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, Chang SL, Karakiewicz PI, Menon M, Olugbade K Jr, Ruhotina N et al (2014) Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. J Endourol 28(7):831–840

    Article  PubMed  Google Scholar 

  16. Anderson BB, Heiman J, Large T, Lingeman J, Krambeck A (2019) Trends and perioperative outcomes across major benign prostatic hyperplasia procedures from the ACS-NSQIP 2011–2015. J Endourol 33(1):62–68

    Article  PubMed  Google Scholar 

  17. Monn MF, El Tayeb M, Bhojani N, Mellon MJ, Sloan JC, Boris RS, Lingeman JE (2015) Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate. Urology 86(2):338–342

    Article  PubMed  Google Scholar 

  18. Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Roupret M (2016) Direct comparison of GreenLight Laser XPS photoselective prostate vaporization and GreenLight laser en bloc enucleation of the prostate in enlarged glands greater than 80 ml: a study of 120 patients. J Urol 195(4 Pt 1):1027–1032

    Article  PubMed  Google Scholar 

  19. Elterman DS, Chughtai B, Lee R, Kurlander L, Yip-Bannicq M, Kaplan SA, Te AE (2013) Comparison of techniques for transurethral laser prostatectomy: standard photoselective vaporization of the prostate versus transurethral laser enucleation of the prostate. J Endourol 27(6):751–755

    Article  PubMed  Google Scholar 

  20. Elmansy H, Baazeem A, Kotb A, Badawy H, Riad E, Emran A, Elhilali M (2012) Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol 188(1):216–221

    Article  PubMed  Google Scholar 

  21. Gilfrich C, Leicht H, Fahlenbrach C, Jeschke E, Popken G, Stolzenburg JU, Weissbach L, Zastrow C, Gunster C (2016) Morbidity and mortality after surgery for lower urinary tract symptoms: a study of 95 577 cases from a nationwide German health insurance database. Prostate Cancer Prostatic Dis 19(4):406–411

    Article  CAS  PubMed  Google Scholar 

  22. Kreydin EI, Chyu J, Lerner L (2018) Laser prostate ablation and enucleation: analysis of a national cohort. Int J Urol 25(6):549–553

    Article  PubMed  Google Scholar 

  23. Malik RD, Wang CE, Lapin B, Gerber GS, Helfand BT (2015) Comparison of patients undergoing laser vaporization of the prostate versus TURP using the ACS-NSQIP database. Prostate Cancer Prostatic Dis 18(1):18–24

    Article  CAS  PubMed  Google Scholar 

  24. Kampantais S, Dimopoulos P, Tasleem A, Acher P, Gordon K, Young A (2018) Assessing the learning curve of holmium laser enucleation of prostate (HoLEP). A systematic review. Urology 120:9–22

    Article  PubMed  Google Scholar 

  25. Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, Lightner DJ, Parsons JK, Roehrborn CG et al (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline. J Urol 200(3):612–619

    Article  PubMed  Google Scholar 

  26. Marien T, Kadihasanoglu M, Miller NL (2016) Holmium laser enucleation of the prostate: patient selection and perspectives. Res Rep Urol 8:181–192

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Alexander CE, Scullion MM, Omar MI, Yuan Y, Mamoulakis C, N'Dow JM, Chen C, Lam TB (2019) Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 12:9629

    Google Scholar 

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Author notes

  1. Nassib Abou Heidar and Muhieddine Labban equally contributed to the manuscript.

Authors and Affiliations

  1. Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon

    Nassib Abou Heidar, Muhieddine Labban & Albert El-Hajj

  2. American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon

    Aurelie Mailhac & Hani Tamim

  3. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misrai

Authors
  1. Nassib Abou Heidar
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  2. Muhieddine Labban
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  3. Vincent Misrai
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  4. Aurelie Mailhac
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  5. Hani Tamim
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  6. Albert El-Hajj
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Contributions

AH: protocol/project development and manuscript writing/editing. ML: manuscript writing/editing and data analysis. VM: manuscript writing/editing. AM: data collection or management, and data analysis. HT: protocol/project development and data analysis. AE-H: protocol/project development and manuscript writing/editing.

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Correspondence to Albert El-Hajj.

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Heidar, N.A., Labban, M., Misrai, V. et al. Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database. World J Urol 38, 2891–2897 (2020). https://doi.org/10.1007/s00345-020-03100-7

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  • DOI: https://doi.org/10.1007/s00345-020-03100-7

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