Does Resectoscope Sheath Size Influence Holmium Laser Enucleation of the Prostate Outcomes? A Prospective Randomized...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Holmium laser enucleation of the prostate (HoLEP) is a standard treatment for benign prostatic hyperplasia.
• The choice of scope size (24F vs. 28F) is debated, with larger scopes potentially offering better flow and visibility, while smaller scopes may be less traumatic.

Purpose of the Study:

• To compare the outcomes of ambulatory HoLEP using 24F and 28F laser scopes.
• To evaluate the impact of scope size on surgical duration, surgeon experience, and postoperative patient results.

Main Methods:

• A randomized controlled trial comparing 24F and 28F scopes in patients undergoing HoLEP for prostates <200 cm³.
• Primary outcome: surgical duration. Secondary outcomes: surgeon-reported scope performance, same-day trial of void (SDTOV), length of stay (LOS), same-day discharge (SDD), and 90-day complications.

Main Results:

• No significant differences in patient characteristics, procedural duration, or efficiencies between the 24F and 28F groups.
• The 28F scope demonstrated improved surgeon-graded irrigation flow and visibility (p < 0.001).
• Patients in the 28F group had higher rates of effective SDTOV (94.3% vs. 82.1%, p = 0.048) and shorter LOS (7.0 vs. 11.9 hours, p = 0.014), but SDD rates were not statistically different.

Conclusions:

• Scope size (24F vs. 28F) in HoLEP did not reveal clear intraoperative or postoperative advantages at 3-month follow-up.
• The 28F scope may be beneficial for shortening LOS and increasing SDTOV rates when same-day discharge is a goal.