Comparison of Robotic vs Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia

To compare robotic transabdominal enucleation of the prostate (RTEP) and laser enucleation of the prostate (LEP) concerning perioperative and functional outcomes for the treatment of benign prostatic hyperplasia (BPH).

This retrospective cohort study included 476 patients who underwent RTEP (n = 68) or LEP (n = 408) from 2014 to 2021. Data collected included demographic information, preoperative characteristics, and perioperative details such as surgical time, blood loss, complications, and length of stay. Postoperative outcomes, including post-void residual (PVR), bladder neck contracture (BNC), and stress urinary incontinence (SUI), were also evaluated. Statistical analysis was performed using univariable and multivariable logistic regression.

Baseline characteristics were similar between groups, except for prostate size (RTEP: 125 g vs LEP: 94 g; p < 0.001). LEP patients had shorter surgery times (139 vs 190 minutes; p < 0.001), lower blood loss (75 vs 255 mL; p < 0.001), and shorter hospital stays (1 vs 2 days; p < 0.001). RTEP had greater postoperative complications (34.3% vs 19.7%; p = 0.007) but no difference in Grade ≥3a complications (5.9% vs 3.7%; p = 0.417). Notably, RTEP had lower rates of transient (4.4% vs 21.3%) and prolonged (4.4% vs 15.1%) SUI. No differences were noted between groups for PVR, BNC, or irritative voiding symptoms. Patients undergoing RTEP had a 75% lower risk of prolonged SUI after surgery than LEP on multivariable analysis. The final rate of unresolved, prolonged SUI was not different between groups (2.9% vs 5.7%).

RTEP and LEP are safe and effective treatments for large-volume BPH. Although LEP offers advantages in shorter operative time and recovery, RTEP is associated with a significantly lower rate of prolonged urinary incontinence.