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Comparison of perioperative and short-terms outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Background

Surgical treatment of symptomatic benign prostatic hyperplasia (BPH) has seen an evolution during the last decades. On one hand, en-bloc HoLEP emerged as a valid endoscopic treatment regardless prostate size. On the other hand, robot-assisted simple prostatectomy (RASP) has gained attention in larger prostates showing encouraging results. Herein, for the first time in the scientific scenario, we sought to compare the outcomes of RASP and en-bloc HoLEP cases after propensity-score matching (PSM) analysis.

Methods

We retrospectively queried our prospectively database of patients treated with HoLEP or RASP between 2017 and 2022 among two high-volume centers. PSM was applied based on the International Prostate Symptom Score (IPSS) questionnaire, prostate volume and max-flow rate. All procedures were performed by a single surgeon per center. Outcomes were assessed at 1, 3, and 6-month postoperatively and therefore annually. Trifecta definition was used to assess “success” in surgical procedures and was defined as the contemporary presence of: a) no postoperative complications within the first postoperative month; b) 1-month postoperative Qmax >15 ml/s and c) no urinary incontinence at 3-month evaluation.

Results

Overall, 48 HoLEP and 47 RASPs were matched. Operative time, hospitalization time (median 4 vs 5 days) and catheterization time (median 3 vs 2 day) were found to be shorter in the HoLEP group as compared to the counterpart (p < 0.05). Early postoperative complication rate was also lower in the HoLEP cohort (6.2% vs 12.6%; p = 0.03) as well as postoperative haemoglobine blood level drop (1.4 vs 2.4 g/dL; p = 0.03). On the other hand, postoperative antegrade ejaculation (55.3% vs 6.8%) 1-month max flow (median 28 vs 24 ml/sec) and continence rates (0% vs 20.8%) favored RASP (p < 0.05). Overall, Trifecta rate was similar in the two groups (76.1% vs 82.6%).

Conclusion

Both HoLEP and RASP are safe and effective treatments for symptomatic BPH. HoLEP demonstrated to have lower perioperative risks while is affecting by a higher probability of transient early UI. On the other hand, RASP is more effective in reducing postoperative ejaculatory dysfunction.

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Dataset in which data have been collected and employed for the present study is available to the corresponding author.

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Authors and Affiliations

  1. Department of experimental and clinical Medicine—University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy

    Antonio Andrea Grosso, Fabrizio Di Maida, Andrea Cocci, Matteo Salvi, Andrea Mari, Andrea Minervini & Agostino Tuccio

  2. Division of Urology, Department of Oncology, University of Turin, Turin, Italy

    Daniele Amparore, Sabrina de Cillis, Alberto Quarà, Cristian Fiori & Francesco Porpiglia

  3. Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy

    Michele Di Dio

  4. Urology Section, University of Catania, Catania, Italy

    Giorgio Ivan Russo & Sebastiano Cimino

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Contributions

AAG: project development and manuscript writing. DA: manuscript writing, Data collection and analysis. FDiM: Data collection and analysis. SdeC: Data collection. AC: Data collection. MDiD: Data collection. GIR: Manuscript editing. SC: Data collection. AQ: Data collection. MS: Data collection. CF: Manuscript editing. Andrea Mari: Manuscript editing. FP: Project development and manuscript editing. Andrea Minervini: Project development and manuscript editing. AT: Project development and manuscript writing.

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Correspondence to Antonio Andrea Grosso.

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Informed consent Informed consent was obtained from all individual participants included in the study. All the procedures were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Grosso, A.A., Amparore, D., Di Maida, F. et al. Comparison of perioperative and short-terms outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00743-6

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