A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium La
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TOPIC PAPER
A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP) Giorgio Bozzini1,7 · Lorenzo Berti1,2 · Tahsin Batuhan Aydoğan2 · Matteo Maltagliati1,2 · Jean Baptiste Roche3,7 · Pierluigi Bove4 · Umberto Besana1 · Alberto Calori1 · Antonio Luigi Pastore5 · Alexander Müller6 · Salvatore Micali2,7 · Maria Chiara Sighinolfi2 · Bernardo Rocco2,7 · Carlo Buizza1 Received: 20 June 2020 / Accepted: 21 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. Methods A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Qmax). Results Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Qmax, PVR, IPSS and QoL score during follow-up. Conclusion ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference. Keywords Benign prostatic hyperplasia · Lower urinary tract symptoms · Endoscopic · Enucleation of the prostate · Endourology · Holmium · Thulium · Laser · HoLEP · ThuLEP
* Giorgio Bozzini [email protected] 1
Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
2
Department of Urology, Università Degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
3
Department of Urology, Clinique Saint Augustin, Bordeaux, France
4
Department of Urology, Ospedale San Carlo di Nancy, Roma, Italy
5
Department of Urology, Università degli Studi di Roma La Sapienza, ICOT (LT), Rome, Italy
6
Department of Urology, Spital Limmattal, Schlieren, Switzerland
7
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