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Related Experiment Video

Updated: Jul 22, 2025

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
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Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison.

Alfredo Maria Bove1, Aldo Brassetti1, Mario Ochoa1

  • 1Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy.

Central European Journal of Urology
|July 24, 2023
PubMed
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Reply to Gianluca Giannarini, Antonio Amodeo, Angelo Porreca and Alessandro Crestani's Letter to the Editor Re: Aldo Brassetti, Gabriele Tuderti, Umberto Anceschi, et al. Sutureless Purely Off clamp Robotic Partial Nephrectomy: Evidence from a Randomized Controlled Noninferiority Trial. Eur Urol 2026;15:S0302-2838(26)02139-1.

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Single-port versus multi-port robotic radical prostatectomy: a within-surgeon, propensity-matched analysis of platform-related effects.

Journal of robotic surgery·2026

Robot-assisted simple prostatectomy (RASP) shows better outcomes than holmium laser enucleation of the prostate (HOLEP) for large prostates. RASP achieved a higher Trifecta rate, indicating superior surgical quality in treating benign prostatic obstruction.

Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Outcomes

Background:

  • Benign prostatic obstruction (BPO) affects a significant number of men, with large prostates (≥80 g) often requiring surgical intervention.
  • Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HOLEP) are leading surgical options for BPO in large prostates.
  • Current evidence lacks definitive randomized controlled trials comparing the long-term efficacy and safety of RASP versus HOLEP.

Purpose of the Study:

  • To compare peri-operative and mid-term outcomes between RASP and HOLEP for treating symptomatic BPO in patients with large prostates (≥80 g).
  • To evaluate the achievement of the Trifecta composite outcome as a measure of surgical quality.
  • To identify predictors of successful Trifecta achievement following these procedures.
Keywords:
HOLEPTrifectabenign prostatic obstructionfunctional outcomesrobot-assisted simple prostatectomy

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Main Methods:

  • A retrospective analysis of prospectively maintained institutional databases from 2011-2021.
  • Inclusion criteria: patients with prostate volume ≥80 g undergoing surgery for BPO.
  • Comparison of demographics, baseline characteristics, and 12-month outcomes, including the Trifecta composite outcome (Q-max >15 ml/sec, IPSS <8, no complications). Statistical analyses included chi-squared and Student t-tests, with logistic regression for predictor analysis.

Main Results:

  • A total of 97 patients were included (43 RASP, 54 HOLEP), with comparable pre-operative characteristics and median prostate volume of 102 g.
  • The overall Trifecta rate was 43%, significantly higher in the RASP group (56%) compared to the HOLEP group (33%) (p=0.02).
  • The endoscopic surgical approach was identified as the sole independent predictor of Trifecta achievement (OR 0.5; p=0.016).

Conclusions:

  • Robot-assisted simple prostatectomy (RASP) demonstrated a significantly higher rate of Trifecta achievement compared to holmium laser enucleation of the prostate (HOLEP).
  • Surgical approach, specifically the endoscopic nature of RASP, was the only independent predictor for achieving optimal surgical outcomes.
  • These findings suggest RASP may offer superior quality of outcomes for patients with large prostates experiencing benign prostatic obstruction.