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Minerva Urologica e Nefrologica 2020 Nov 17

DOI: 10.23736/S0393-2249.20.04043-6


language: English

Holmium laser enucleation of prostate versus minimally invasive simple prostatectomy for large volume (≥ 120 ml) prostate glands: a prospective multicenter randomized study

Andrea FUSCHI 1, 2, Yazan AL SALHI 1, 2, Gennaro VELOTTI 1, Lorenzo CAPONE 1, Alessia MARTOCCIA 1, Paolo P. SURACI 1, Silvio SCALZO 1, Filippo ANNINO 3, Saba KHORRAMI 3, Anastasios ASIMAKOPOULOS 4, Giorgio BOZZINI 5, Mario FALSAPERLA 6, Antonio CARBONE 1, 7, Antonio L. PASTORE 1, 7

1 Urology Unit, Department of Medico - Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy; 2 ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy; 3 Urology Unit, San Donato Hospital, Arezzo, Italy; 4 Urology Unit, Tor Vergata Hospital, Rome, Italy; 5 Urology Unit, Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy; 6 Urology Unit, ARNAS Garibaldi Hospital, Catania, Italy; 7 Uroresearch, Non-profit Urology Research Association, Latina, Italy


BACKGROUND: The aim of this study was to compare the perioperative and functional results between laparoscopic and robot-assisted simple prostatectomy (LSP and RASP) and Holmium laser enucleation of prostate (HoLEP) in prostate volumes ≥ 120 ml. The primary endpoint was to investigate and compare minimally invasive techniques in the management of large prostate gland volume, and the secondary endpoint was to evaluate the frequency and type of postoperative complications according to Clavien Dindo classification.
METHODS: This multicentre study was conducted on male patients with LUTS associated with BPO candidates for surgical treatment. The surgery approach choice in relation to the prostatic volume ≥ 120 ml was HoLEP or minimally invasive simple prostatectomy (LSP or RASP). All patients were prospectively randomized into three groups, according to a simple computed randomization: HoLEP, LSP and RASP groups. During the follow-up, all patients underwent post-operative control at 1, 3, 6, 12 and 24 months from the surgical procedure.
RESULTS: 110 male patients were randomized in three homogeneous groups: 36 in LSP, 32 in RASP and 42 in HoLEP group. During the follow-up (mean 26.15 months), despite the significant improvement compared to baseline results, no significant differences were shown, between the groups in terms of functional and perioperative outcomes. The only statistically significant data was reported for catheterization time, that resulted longer in the LSP group than RASP and HoLEP groups (p value: 0.002). Furthermore, MISP resulted in longer hospitalization, and lower rate of patients with new-onset irritative symptoms.
CONCLUSIONS: This prospective randomized study is the first to compare extraperitoneal LSP, RASP and HoLEP in the treatment of LUTS secondary to benign prostatic hyperplasia for prostate volumes ≥ 120 ml. Our findings confirm the safety and efficacy of MISP, demonstrating its equivalence in functional outcomes and perioperative morbidity in comparison to HoLEP.

KEY WORDS: LUTS, robot-assisted laparoscopy; Holmium laser; Benign prostatic hyperplasia; Extraperitoneal; Trans-capsular; Simple prostatectomy

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