The following is a summary of “Holmium Laser Enucleation of the Prostate vs Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands,” published in the NOVEMBER 2023 issue of Urology by Palacios, et al.
For a study, researchers sought to compare the perioperative outcomes between transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP) in patients with a preoperative prostatic volume (PPV) exceeding 80 cm3.
A retrospective review was conducted on patients undergoing SP-RASP and HoLEP between 2019 and 2022 with a PPV >80 cm3. The percentage of prostate adenoma removed (%PAR) was calculated by normalizing specimen weight to PPV. Univariate analysis included chi-square, Fisher exact, and Wilcoxon rank-sum tests. Additionally, a subgroup analysis with 1:1 matching for PPV was performed.
The analysis included 50 SP-RASP and 90 HoLEP cases. The median (interquartile range) PPV was 169 (128-244) cm3 for SP-RASP and 129 (100-150) cm3 for HoLEP (P < .01). The median %PAR was 57 (44-68) for SP-RASP vs. 51 (42-62) for HoLEP (P = .10). Complications occurred in 12% of HoLEP and 10% of SP-RASP patients (P = .51). Same-day discharge occurred in 48% of SP-RASP vs. 8% of HoLEP patients (P < .01). Median foley catheter duration was longer in SP-RASP (6 vs. 1 day, P < .01), and the trial of void was successful at the first attempt in >94% (P = .68). Transient de novo incontinence was reported in 28% of HoLEP vs. 5% of SP-RASP cases (P < .01). No differences in voiding parameters were observed at the latest follow-up. Subgroup postmatched analysis revealed analogous findings.
SP-RASP and HoLEP exhibited comparable favorable perioperative outcomes for managing large prostatic adenomas. SP-RASP may be considered for patients averse to the risk of transient incontinence and those with unfavorable urethral access, large bladder stone burden, or diverticula.
Source: goldjournal.net/article/S0090-4295(23)00659-3/fulltext
