Holmium laser enucleation of the prostate vs monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Objective
The aim was to compare the efficacy, safety, and cost-effectiveness of holmium laser enucleation of the prostate (HoLEP) vs monopolar transurethral resection of the prostate (TURP) in the management of benign prostatic hyperplasia.
Materials and methods
Between February 2018 and February 2020, 70 patients who underwent surgical treatment for benign prostatic hyperplasia were randomized into two equal groups, representing HoLEP and monopolar TURP. All the patients were assessed preoperatively and followed up for 12 months postoperatively. The primary preoperative and postoperative parameters were the international prostate symptom score (IPSS) and maximum urine flow rate (Qmax), whereas the secondary parameters were operative time, resected volume, postoperative drop in hemoglobin level, postoperative change in sodium level, postoperative catheterization time, duration of hospital stay, and postvoiding residual urine. All complications were recorded. Cost analysis was evaluated.
Results
A total of 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study. Mean baseline prostate sizes were similar in both groups. HoLEP group had longer operative time of 80 min compared with 60 min in the TURP group. HoLEP was associated with shorter postoperative catheter time and hospital stay compared with those of TURP group. There were no statistically significant differences between both groups regarding perioperative parameters such as resected volume, hemoglobin drop, and sodium level drop. Moreover, postoperative international prostate symptom score, Qmax, postvoiding residual urine, prostatic specific antigen, and quality of life were comparable in both groups. There was no statistically significant difference between both groups regarding postoperative complications. Regarding cost analysis, HoLEP was more cost-effective than TURP.
Conclusion
Both HoLEP and monopolar TURP are safe and effective. However, HoLEP has shorter catheterization time and hospital stay and was more cost-effectiveness but had longer operative time than monopolar TURP.