Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NS
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ORIGINAL ARTICLE
Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database Nassib Abou Heidar1 · Muhieddine Labban1 · Vincent Misrai3 · Aurelie Mailhac2 · Hani Tamim2 · Albert El‑Hajj1 Received: 21 November 2019 / Accepted: 19 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. Results The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47–0.58) times the odds of a LOS > 1 day and 0.67 (0.54–0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. Conclusion Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time. Keywords Benign prostatic obstruction · Laser enucleation of the prostate · Prostatic adenoma · Transurethral resection of the prostate
Introduction
Nassib Abou Heidar and Muhieddine Labban equally contributed to the manuscript. * Albert El‑Hajj [email protected] 1
Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El‑Solh, Beirut 1107 2020, Lebanon
2
American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
3
Department of Urology, Clinique Pasteur, Toulouse, France
Aging male patients often complain of lower urinary tract symptoms (LUTS) that are commonly attributed to benign prostatic obstruction (BPO), which are classically managed with either monopolar transurethral resection of the prostate (TURP) or open simple prostatectomy (OP) [1, 2]. Although monopolar TURP has stood the test of time, it is not risk free, with complications including bleeding, transurethral syndrome (TUR syndrome), bladder neck stenosis, a
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