Superior Long-Term Clinical Outcomes with HoLEP as Compared to TURP in the Treatment of Benign Prostate Hyperplasia

Introduction

The safety and efficacy associated with transurethral resection of the prostate (TURP) makes it the gold standard for treatment of benign prostate hyperplasia (BPH). However, the perioperative morbidity associated with this technique is a cause of concern. Previous meta-analyses show that holmium laser enucleation of the prostate (HoLEP) might be an alternative to TURP. Nevertheless, there is lack of long-term follow-up clinical data.

Aim

This is an updated meta-analysis which compares efficacy and safety of HoLEP and TURP using all the relevant randomized clinical trials (RCTs) available in the literature.

Method

Study Design

• Meta-analysis of randomized clinical trials (RCTs)
• RCTs were identified using MEDLINE, EMBASE, Cochrane Library and Web of Science databases
• RCTs comparing the efficacy and safety of HoLEP and TURP were included
• The prostate sizes of all the studies were smaller than 100 g

Endpoints

• Operation time
• Drop in hemoglobin levels
• Duration of hospital stay
• Catheterization time
• Bladder irrigation
• Maximum urinary flow rate (Qmax)
• International prostate symptom score (IPSS)
• Quality of life (QoL) score
• Postvoid residual urine volume (PVR)
• American Urological Association Symptom Score (AUA)
• Adverse events

Results

• A total of 11 RCTs comprising of 672 cases of HoLEP and 667 cases of TURP were included
• 9 RCTs had a minimum follow-up of 12 months and 4 RCTs presented the follow-up of 24 months after the operation
• The perioperative results associated with HoLEP are shown in table 1.

• Although the difference in Qmax at 1 month and 6 months were similar in both the groups, HoLEP was associated with a higher Qmax at 12 and 24 months postoperatively
• HoLEP group demonstrated an improvement in PVR at 6 and 12 months with WMD of -7.56 (p<0.0001) and -15.46 (p<0.00001) respectively
• The improvement in IPSS at 12 months with HoLEP was significant (WMD -0.76; p=0.002)
• The differences in the QoL and AUA scores at months 1, 6, 12 and 24 were insignificant across both the groups
• The risk of blood transfusion was significantly lower in the HoLEP group (relative risk 0.18; p=0.0005) but higher risk of transient dysuria (RR 1.86; p=0.005)  

Conclusion

• In patients with small to mid-sized prostates, holmium laser enucleation of the prostate (HoLEP) was associated with longer operation time, less drop in hemoglobin levels, less blood transfusion, shorter hospital stay and shorter catheterization time as compared to transurethral resection of prostate (TURP)
• Superior long-term clinical outcomes were demonstrated by HoLEP in urodynamic parameters

Urology 2019;131:14-20.