title: Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?
abstract: OBJECTIVE
  To assess the functional outcome and cumulative health-resource-related cost of holmium laser enucleation of the prostate (HoLEP) in comparison with transvesical open prostatectomy (TVOP) in a developing country.
  
  
  METHODS
  Matching of 92 HoLEP and 91 TVOP procedures was performed using resected prostate tissue weight as a sole matching criterion. Safety, efficacy, and accordingly health-related cost-efficiency of both procedures were statistically compared.
  
  
  RESULTS
  Preoperative criteria and mean prostate size (166.7 ± 49.7, 161.4 ± 35.7 ml) were similar in HoLEP and TVOP, respectively; however, HoLEP treated more comorbid patients. Blood transfusion was 2.1 and 26.1 % after HoLEP and TVOP, respectively (P = 0.001). Median time to catheter removal and hospital stay was 2 days after HoLEP and 5 and 9 days, respectively, after TVOP (P < 0.001). On modified Clavien scale, grade per grade, there was no statistically significant difference between the two groups apart from local wound complications in TVOP group. High-grade complications (≥ grade 3) were reported in 3.2 and 6.5 % in HoLEP and TVOP, respectively (P = 0.49). Resected prostate tissue weight was independently associated with high-grade periprocedure complications (OR[95 %CI] 1.22[1.02:1.49], P = 0.03). Last follow-up symptom score, peak urine flow rate, residual urine, % PSA reduction, and need for reoperation were comparable between the two groups. HoLEP costs the hospital in the first 3 months 4111.8EP (575US$) versus 4305.4EP (602US$) for TVOP (P = 0.09).
  
  
  CONCLUSIONS
  In high-volume hospital, HoLEP procedure seems to be equally safe and effective as TVOP with the advantages of minimally invasive procedures. Two years after adopting the technique, HoLEP equally costs the hospital as TVOP. Significant hospital cost savings are anticipated in subsequent cases.
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt. elshalam@hotmail.com.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Ramy
authors.initials: R
authors.lastname: Mekkawy
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Laymon
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Barakat
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Elsaadany
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Assmy
authors.affiliation: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria Street, Mansoura, DK, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: El-Nahas
mesh_terms: D003906:Developing Countries; D004534:Egypt / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome
keywords: Holmium; Laser; Prostate; Prostatectomy; Transurethral; Transvesical