Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center.
We report a comparative analysis of robotic assisted simple prostatectomy vs holmium laser enucleation of the prostate in patients who had benign prostatic hyperplasia with a large volume prostate (greater than 100 ml).



A total of 81 patients underwent robotic assisted simple prostatectomy and 45 underwent holmium laser enucleation of the prostate in a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during followup. Perioperative outcomes included operative time, postoperative hemoglobin, catheterization time and hospitalization. Complications were reported according to the Clavien-Dindo classification.



Compared to the holmium laser enucleation group, patients treated with prostatectomy were significantly younger (median age 69 vs 74 years, p = 0.032) and less healthy (Charlson comorbidity index 2 or greater in 62% vs 29%, p = 0.0003), and had a lower rate of suprapubic catheterization (23% vs 42%, p = 0.028) and a higher preoperative I-PSS (International Prostate Symptom Score) (25 vs 21, p = 0.049). Both groups showed an improvement in the maximum flow rate (15 vs 11 ml per second, p = 0.7), and a significant reduction in post-void residual urine (-73 vs -100 ml, p = 0.4) and I-PSS (-20 vs -18, p = 0.8). Median operative time (105 vs 105 minutes, p = 0.9) and postoperative hemoglobin (13.2 vs 13.8 gm/dl, p = 0.08) were similar for robotic assisted prostatectomy and holmium laser enucleation, respectively. Median catheterization time (3 vs 2 days, p = 0.005) and median hospitalization (4 vs 2 days, p = 0.0001) were slightly shorter in the holmium laser group. Complication rates were similar with no Clavien grade greater than 3 in either group.



Our results from a single center suggest comparable outcomes for robotic assisted simple prostatectomy and holmium laser enucleation of the prostate in patients with a large volume prostate. These findings require external validation at other high volume centers.
University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium. Electronic address: paoloumari@alice.it.
Paolo
P
Umari
Division of Oncology, Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Nicola
N
Fossati
Division of Oncology, Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Giorgio
G
Gandaglia
Department of Urology, Wesley Hospital, Brisbane, Queensland, Australia.
Morgan
M
Pokorny
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Ruben
R
De Groote
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Nicolas
N
Geurts
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Marijn
M
Goossens
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Peter
P
Schatterman
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Geert
G
De Naeyer
Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.
Alexandre
A
Mottrie
D000368:Aged; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000601:surgery*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures
lasers; outcome assessment (health care); prostatectomy; prostatic hyperplasia; robotics; solid-state