International Urology and Nephrology

, Volume 46, Issue 7, pp 1277–1282 | Cite as

Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial

  • Nao Sun
  • Yaowen Fu
  • Tengzheng Tian
  • Jialin Gao
  • Yuantao Wang
  • Song Wang
  • Wei An
Urology - Original Paper
First Online:
Received:
Accepted:

Abstract

Objective

To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), for treatment of benign prostatic hyperplasia (BPH).

Methods

A total of 164 cases of BPH were selected from patients who were hospitalized between January 2010 and December 2011. Patients had received either HoLEP or TURP treatment. Clinical data were collected from the perioperative period, 1 month after surgery, and 12 months after surgery.

Results

There was no significant difference between the two groups in the maximum urinary flow rate (Q max), postvoid residual volume (PVR), international prostate symptom score (IPSS), or quality-of-life score (QOL score) at 1 month after surgery (p = 0.56, p = 0.346, p = 0.536 and p = 0.145, respectively). However, after 12 months, patients from the HoLEP group demonstrated better scores in Q max, PVR, IPSS, and QOL than those from the TURP group (p = 0.037, p = 0.003, p < 0.001 and p = 0.019, respectively). The two groups had comparable operation time (p = 0.105), catheterization time (p = 0.173), and length of hospital stay (p = 0.395), but were statistically different in the weight of resected prostate tissue (p < 0.001), bladder irrigation time (p < 0.001), hemoglobin levels (p = 0.011), and blood sodium levels (p = 0.002) after surgery.

Conclusions

Compared to TURP, HoLEP was safer and had better long-term efficacy as assessed by multiple quantitative measures. Therefore, HoLEP may present a better option in the treatment of BPH.

Keywords

Benign prostatic hyperplasia Holmium laser enucleation Transurethral resection 
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Notes

Conflict of interest

The authors declare they have no outside financial interests that would affect the design or outcomes of this study.

References

  1. 1.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP): incidence, management, and prevention. Eur Urol 50(5):969–979 discussion 980PubMedCrossRefGoogle Scholar
  2. 2.
    Reich O, Seitz M, Gratzke C, Schlenker B, Walther S, Stief C (2010) Benign prostatic hyperplasia (BPH): surgical therapy options. Urologe A 49(1):113–126PubMedCrossRefGoogle Scholar
  3. 3.
    El-Hakim A (2010) TURP in the new century: an analytical reappraisal in light of lasers. Can Urol Assoc J 4(5):347–349PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR (1995) Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol 9(2):151–153PubMedCrossRefGoogle Scholar
  5. 5.
    Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR (1998) Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 12(5):457–459PubMedCrossRefGoogle Scholar
  6. 6.
    Chen Q, Chen YB, Wang Z et al (2012) An improved morcellation procedure for holmium laser enucleation of the prostate. J Endourol 26(12):1625–1628PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Jansen ED, Asshauer T, Frenz M, Motamedi M, Delacrétaz G, Welch AJ (1996) Effect of pulse duration on bubble formation and laser-induced pressure waves during holmium laser ablation. Lasers Surg Med 18(3):278–293PubMedCrossRefGoogle Scholar
  8. 8.
    Cecchetti W, Zattoni F, Nigro F, Tasca A (2004) Plasma bubble formation induced by holmium laser: an in vitro study. Urology 63(3):586–590PubMedCrossRefGoogle Scholar
  9. 9.
    Naspro R, Suardi N, Salonia A et al (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50(3):563–568PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson LC, Gilling PJ, Williams A et al (2006) A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 g: results at 2 years. Eur Urol 50(3):569–573PubMedCrossRefGoogle Scholar
  11. 11.
    Montorsi F, Naspro R, Salonia A et al (2008) 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 179(Suppl. 5):S87–S90PubMedCrossRefGoogle Scholar
  12. 12.
    van Rij S, Gilling PJ (2012) In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new ‘gold standard’. Curr Urol Rep 13(6):427–432PubMedCrossRefGoogle Scholar
  13. 13.
    Gravas S, Bachmann A, Reich O et al (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043PubMedCrossRefGoogle Scholar
  14. 14.
    Placer J, Gelabert-Mas A, Vallmanya F et al (2009) Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. Urology 73(5):1042–1048PubMedCrossRefGoogle Scholar
  15. 15.
    Shah HN, Mahajan AP, Sodha HS, Hegde S, Mohile PD, Bansal MB (2007) Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol 177(4):1468–1474PubMedCrossRefGoogle Scholar
  16. 16.
    Elzayat EA, Elhilali MM (2007) Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol 52(5):1465–1471PubMedCrossRefGoogle Scholar
  17. 17.
    Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 g: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166PubMedCrossRefGoogle Scholar
  18. 18.
    Kuntz RM, Lehrich K, Ahyai S (2004) Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol 18(2):189–191PubMedCrossRefGoogle Scholar
  19. 19.
    Elmansy HM, Elmansy A, Elhilali MM (2011) Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol 186(5):1972–1976PubMedCrossRefGoogle Scholar
  20. 20.
    Gilling PJ, Williams AK (2008) Holmium laser enucleation of the prostate is the single best treatment for benign prostatic hyperplasia refractory to medication. J Endourol 22(9):2113–2115 discussion 2121, 2125PubMedCrossRefGoogle Scholar
  21. 21.
    Krambeck AE, Handa SE, Lingeman JE (2013) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 189(Suppl. 1):S141–S145PubMedCrossRefGoogle Scholar
  22. 22.
    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):408–411PubMedCrossRefGoogle Scholar
  23. 23.
    Tan A, Liao C, Mo Z, Cao Y (2007) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 94(10):1201–1208PubMedCrossRefGoogle Scholar
  24. 24.
    Ahyai SA, Lehrich K, Kuntz RM (2007) Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol 52(5):1456–1463PubMedCrossRefGoogle Scholar
  25. 25.
    Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR (2003) 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 (40–200 g). J Urol 170(4 Pt 1):1270–1274PubMedCrossRefGoogle Scholar
  26. 26.
    Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol 25(8):1347–1352PubMedCrossRefGoogle Scholar
  27. 27.
    Lourenco T, Armstrong N, N’Dow J et al. (2008) Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess 12(35):iii, ix–x, 1–146, 169–515Google Scholar
  28. 28.
    Shah HN, Kausik V, Hegde S, Shah JN, Bansal MB (2006) Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique. J Urol 175(2):537–540PubMedCrossRefGoogle Scholar
  29. 29.
    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):604–611PubMedCrossRefGoogle Scholar
  30. 30.
    Briganti A, Naspro R, Gallina A et al (2006) Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 175(5):1817–1821PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Nao Sun
    • 1
  • Yaowen Fu
    • 1
  • Tengzheng Tian
    • 1
  • Jialin Gao
    • 1
  • Yuantao Wang
    • 1
  • Song Wang
    • 1
  • Wei An
    • 1
  1. 1.Department of Urology, Urology and Nephrology CenterFirst Hospital of Jilin UniversityChangchunChina

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