Holmium Laser Enucleation of the Prostate Versus Open Prostatectomy for Prostates >70 g: 24-Month Follow-up

Objective: Prospectively evaluate perioperative outcomes and 2-yr follow-up after holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for treating benign prostatic hyperplasia-related obstructed voiding symptoms, with prostates >70 g. Methods: From March 2003 to December 2004, 80 consecutive patients were randomised for surgical treatment with HoLEP (n = 41) or standard OP (n = 39). All patients were preoperatively assessed with International Prostate Symptom Score and International Index of Erectile Function questionnaires and complete urodynamic evaluation. Intraoperative and perioperative parameters such as blood loss, catheter removal, and hospital stays were assessed. Early and late complications were recorded. Patients were evaluated at 1-, 3-, 12-, and 24-mo follow-ups with the same tests. Results: Operating room time was significantly shorter for the OP group (72.09 ± 21.22 min vs. 58.31 ± 11.95 min, p <0.0001); catheter removal (1.5 ± 1.07 d and 4.1 ± 0.5 d, p <0.001) and hospital stay (2.7 ± 1.1 d vs. 5.4 ± 1.05 d, p <0.001) were shorter in the HoLEP group. Blood loss was less and blood transfusions fewer in the HoLEP group (p <0.001). In both groups urodynamic and uroflowmetry findings improved from baseline, were still evident at the 24-mo follow-up, and were comparable between the two groups. Late complications were also comparable. Conclusions: HoLEP is a feasible technique for treating large prostates. Functional results are similar to OP at the 2-yr follow-up. Reduced catheterisation, hospital stay, and blood loss make HoLEP an attractive option for the treatment of large prostates.