title: Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g.
abstract: OBJECTIVE
  To compare the safety and efficacy of two alternatives for surgically treating symptomatic benign prostatic hyperplasia (BPH), i.e. transurethral vapour resection of the prostate (TUVRP) and holmium laser enucleation of the prostate (HOLEP), with transurethral resection of the prostate (TURP), the standard surgical therapy, as treating large prostates is associated with greater morbidity, and to date there is no simultaneous comparison of these three methods.
  
  
  METHODS
  We prospectively randomized 150 patients (50 in each group) with BPH and glands of >40 g to undergo either TURP, TUVRP or HOLEP. The evaluation before treatment included urine culture, serum prostate specific antigen (PSA) level estimation, the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q(max)), and transabdominal ultrasonography to estimate prostate size and postvoid urine residue (PVR). The operative duration, blood loss, resected tissue weight, change in levels of haemoglobin and serum sodium, nursing contact time, duration of catheterization, and complications were noted. After surgery patients were reassessed for the IPSS, Q(max) and PVR at 6 months and 1 year.
  
  
  RESULTS
  The patients in all three groups had comparable characteristics before surgery. The mean operating duration and intraoperative irrigant used for TUVRP was less than for HOLEP or TURP, and blood loss with HOLEP and TUVRP was less than with TURP (all P < 0.001). Postoperative irrigation, nursing contact time, and catheter duration were significantly less for HOLEP than TURP or TUVRP, and for TUVRP than TURP. At follow-up, patients in all groups had a significant improvement from baseline in IPSS, Q(max,) and PVR, but the differences between the groups were not significant at 6 months or 1 year.
  
  
  CONCLUSIONS
  HOLEP and TUVRP are both acceptable alternatives to TURP for treating large prostate glands, with less perioperative morbidity and comparable efficacy at 6 months and 1 year.
authors.affiliation: All India Institute of Medical Sciences, Department of Urology, New Delhi, India. narmadagupta@hotmail.com
authors.forename: Narmada
authors.initials: N
authors.lastname: Gupta
authors.lastname: Sivaramakrishna
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.forename: Prem N
authors.initials: PN
authors.lastname: Dogra
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006695:Holmium