Holmium Laser Enucleation of the Prostate Versus Bipolar Resection of the Prostate: A Prospective Randomized Study. "Pros and Cons"

Objective: To compare the safety, efficacy, and applicability of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral resection of the prostate (TURPb) procedures, whereas the secondary objective is to find out the advantages and disadvantages of each.

Patients And Methods: A prospective randomized study included 120 patients with benign prostatic hyperplasia that required intervention. The patients were randomized in 2 equal groups: group A managed by HoLEP and group B managed by TURPb. The mean age, International Prostate Symptom Score, maximum urine flow, residual urine, operative time, blood loss, resected volume, catheterization time, hospital stay, and costs were compared.

Results: Both groups were comparable regarding the preoperative parameters. The mean operative time was statistically significantly longer in the HoLEP group. The drop in the hemoglobin level was statistically significantly in group B. The mean resected prostatic volume was 61.167 g in the HoLEP group and 58.8 g in the TURPb group. The catheter was removed after 24 hours in 51 and 36 patients in groups A and B, respectively. The International Prostate Symptom Score at 1 and 12 months and the maximum urine flow at 12 months postoperatively were found to be better in the HoLEP group than in the bipolar group, and this difference was found to be statistically significant.

Conclusion: Although the HoLEP technique is associated with a relatively longer operative time, it has proved to be effective in treating large prostates with minimal morbidity, better hemostasis, less blood loss, and better voiding pattern than TURPb after a 12-month follow-up.