To report a comparative analysis of Robotic-assisted Simple Prostatectomy (RASP) versus Holmium Laser Enucleation of Prostate (HoLEP) in Benign Prostatic Hyperplasia (BPH) patients with large volume prostates (>100ml).
81 patients underwent RASP and 45 underwent HoLEP over a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during the follow-up. Perioperative outcomes included operative time (OR time), postoperative hemoglobin (post-op Hb), catheterization time (CV time) and hospitalization (LOS). Complications were reported according to Clavien-Dindo classification.
Compared to HoLEP group, patients treated with RASP were significantly younger (median age: 69 vs. 74 years, p=0.032), less healthy (CCI≥2: 62% vs. 29%, p=0.0003), had a lower rate of supra-pubic catheter (23% vs. 42%, p=0.028) and a higher pre-operative IPSS (25 vs. 21, p=0.049). Both groups showed an improvement of maximum flow rate (+15 vs +11ml/s, p=0.7), a significant reduction of post-void residual (-73 vs -100ml, p=0.4) and International Prostate Symptom Score (-20 vs -18, p=0.8). The median OR time (105 vs 105min; p=0.9) and post-op Hb (13.2 vs 13.8g/dl; p=0.08) were similar in RASP and HoLEP, respectively. The median CV time (3 vs 2 days; p=0.005) and LOS (4 vs 2 days; p=0.0001) were slightly shorter for the HoLEP group. Complication rates were similar with no Clavien >3 grade in both groups.
Our results from a single center suggest comparable outcomes between RASP and HoLEP in patients with large volume prostates, but require external validation at other high-volume centers.
The Journal of urology. 2016 Sep 08 [Epub ahead of print]
Paolo Umari, Nicola Fossati, Giorgio Gandaglia, Morgan Pokorny, Ruben De Groote, Nicolas Geurts, Marijn Goossens, Peter Schatterman, Geert De Naeyer, Alexandre Mottrie
University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium. Electronic address: ., Division of Oncology / Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium., Department of Urology, The Wesley Hospital, Brisbane, Australia., Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.