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Published on: January 7, 2019
Urodynamics after TURP and HoLEP in urodynamically obstructed patients: are there any differences at 1 year of
Lorenzo Rigatti1, Richard Naspro, Andrea Salonia
1Department of Urology, University Vita-Salute Scientific Institute H. San Raffaele, Milan, Italy.
Insights
Holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) offer comparable outcomes for benign prostatic hyperplasia. HoLEP demonstrated shorter catheterization and hospital stays, despite increased early irritative symptoms.
Area of Science:
- Urology
- Surgical Innovation
- Lower Urinary Tract Symptoms
Background:
- Benign prostatic hyperplasia (BPH) frequently causes bladder outlet obstruction.
- Holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are common surgical treatments.
- Comparing urodynamic outcomes of HoLEP and TURP is crucial for treatment selection.
Purpose of the Study:
- To compare urodynamic findings between HoLEP and TURP in patients with BPH-related bladder outlet obstruction.
- To evaluate the efficacy and safety of HoLEP versus TURP through objective urodynamic parameters and subjective symptom scores.
Main Methods:
- A randomized controlled trial involving 100 patients with BPH and obstructive lower urinary tract symptoms.
- Patients were assigned to either HoLEP (n=52) or TURP (n=48).
- Preoperative and 1, 6, 12-month postoperative assessments included urodynamics, International Prostate Symptom Score (IPSS), and quality-of-life (QoL) scores.
Main Results:
- Both HoLEP and TURP effectively relieved bladder outlet obstruction, with no significant differences in urodynamic parameters (e.g., detrusor pressure, maximal flow rate) or IPSS/QoL scores at 12 months.
- HoLEP group showed significantly shorter catheterization times and hospital stays.
- HoLEP group experienced more transient lower urinary tract symptoms and dysuria in the early postoperative period.
Conclusions:
- HoLEP and TURP are equally effective in relieving bladder outlet obstruction due to BPH.
- HoLEP offers advantages of shorter catheterization and hospital stay, despite a higher incidence of early irritative symptoms.
- HoLEP presents a viable alternative to TURP for managing BPH-related bladder outlet obstruction.
Objectives:
To compare urodynamic findings after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia-related bladder outlet obstruction.
Methods:
From January to October 2002, 100 consecutive patients with benign prostatic hyperplasia with obstructive lower urinary tract symptoms were randomized to surgical treatment with either HoLEP (group 1, n = 52) or TURP (group 2, n = 48). All patients were preoperatively assessed using the International Prostate Symptom Score and quality-of-life question, total serum prostate-specific antigen measurement, transrectal ultrasonography, and complete urodynamic study. The operative time, catheterization time, and overall hospital stay were also recorded for both groups. All patients were assessed at 1, 6, and 12 months postoperatively using a complete urodynamic evaluation.
Results:
All patients were obstructed preoperatively (Schäfer grade greater than 2). Both groups were comparable in terms of age, total serum prostate-specific antigen level, International Prostate Symptom Score, and urodynamic results. At 1, 6, and 12 months of follow-up, no statistically significant differences were recorded in terms of detrussor pressure at maximal urinary flow rate, Schäfer grade (linear passive urethral resistance relation), maximal urinary flow rate, International Prostate Symptom Score, and quality-of-life score. In the HoLEP group, the catheterization time and hospital stay were significantly shorter. Transitory lower urinary tract symptoms after 3 months of follow-up and dysuria were more frequent in the HoLEP group than in the TURP group, although at 12 months of follow-up, the results were comparable.
Conclusions:
Both HoLEP and TURP were equally effective in relieving bladder outlet obstruction. Although associated with greater early self-resolving irritative symptoms, HoLEP can guarantee a shorter catheterization time and hospital stay with longer operative times, proposing itself as an attractive alternative to standard TURP.
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