HoLEP versus ThuFLEP in men with very large prostates (> 175 ml)

We aimed to demonstrate and compare the efficacy and safety of HoLEP and ThuFLEP procedures in patients with very large prostates (> 175 ml).

Patients with prostates larger than 175 ml who underwent HoLEP (Group 1, n = 72) and ThuFLEP (Group 2, n = 85) for benign prostatic obstruction (BPO) were retrospectively analysed. Perioperative, postoperative functional outcomes and complications were analysed and compared.

Significant improvements were observed in functional parameters related to IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at 1, 6 and 12 months postoperatively. Except for IPSS at the first postoperative month (3.22 ± 1.77 vs. 2.07 ± 1.11; p = 0.001), no difference was observed between the groups in terms of quality of life, IPSS, Qave and PVR at the sixth and twelfth months. There was no significant difference between the laser sources in terms of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) at 1 month postoperatively, and no UI was observed in any patient at 6 and 12 months. No significant difference was observed between laser types in terms of postoperative complications.

HoLEP and ThuFLEP are safe and effective minimal invasive surgical methods in very large prostates with improvement in postoperative functional parameters and low perioperative complication rates. Since there are no significant differences in outcomes between these laser sources, they can be employed as alternative surgical techniques for BPO in patients with very large prostates.