title: Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas.
abstract: OBJECTIVE
  The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy.
  
  
  METHODS
  We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test.
  
  
  RESULTS
  There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99).
  
  
  CONCLUSIONS
  Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay.
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia. Electronic address: rjuaneda@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Juaneda
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia.
authors.forename: R
authors.initials: R
authors.lastname: Thanigasalam
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia.
authors.forename: J
authors.initials: J
authors.lastname: Rizk
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia.
authors.forename: E
authors.initials: E
authors.lastname: Perrot
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia.
authors.forename: P E
authors.initials: PE
authors.lastname: Theveniaud
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, París, Francia.
authors.forename: H
authors.initials: H
authors.lastname: Baumert
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*
keywords: Adenomectomía laparoscópica; Benign prostatic hyperplasia; Grandes adenomas; Hiperplasia prostática benigna; HoLEP; Laparoscopic simple prostatectomy; Large adenomas; Minimally invasive techniques; Técnicas mínimamente invasivas