title: A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years.
abstract: OBJECTIVE
  To compare holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) for treatment of men with bladder outflow obstruction (BOO) secondary to benign prostatic hyperplasia with a minimum of 24-month follow-up.
  
  
  METHODS
  Sixty-one patients were randomised to either HoLEP or TURP. All patients had BOO proven on urodynamic studies pre-operatively (prostate size 40-200 g). One patient died before treatment, which left 30 patients in each group. Perioperative data, as well as symptom scores, Quality of Life (QoL) scores, and maximum urinary flow rates (Qmax) were obtained at one, three, six,12, and 24 months. Post-void residual volumes, transrectal ultrasound (TRUS) volumes, and pressure flow studies were obtained six months post-operatively. Continence and potency data were also recorded.
  
  
  RESULTS
  There were no significant differences between the two surgical groups pre-operatively. Mean pre-operative TRUS volume was 77.8+/-5.6 g (42-152) in the HoLEP group and 70.0+/-5.0 g (46-156) in the TURP group. Patients in the HoLEP group had shorter catheter times and hospital stays. More prostate tissue was retrieved in the HoLEP group. At six months, HoLEP was urodynamically superior to TURP in relieving BOO. At 24 months, there was no significant difference between the two surgical groups with respect to American Urology Association scores, QoL scores, or Qmax values; however, two patients in the TURP group required re-operation.
  
  
  CONCLUSIONS
  HoLEP has less perioperative morbidity and produces superior urodynamic outcomes than TURP, when treating prostates >40 g. At 24 months of follow-up, HoLEP is equivalent to TURP.
authors.affiliation: Department of Urology, Tauranga Hospital, Tauranga, New Zealand.
authors.forename: Liam C
authors.initials: LC
authors.lastname: Wilson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gilling
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.forename: Katie M
authors.initials: KM
authors.lastname: Kennett
authors.forename: Chris M
authors.initials: CM
authors.lastname: Frampton
authors.forename: Andre M
authors.initials: AM
authors.lastname: Westenberg
authors.forename: Mark R
authors.initials: MR
authors.lastname: Fraundorfer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D007172:Erectile Dysfunction / Q000453:epidemiology; D006695:Holmium / Q000627:therapeutic use*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D011467:Prostate / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D014549:Urinary Incontinence / Q000453:epidemiology
chemical_list: D006695:Holmium