A minimally invasive laser procedure known as HoLEP is becoming a popular alternative to the more established TURP in treating benign prostatic hyperplasia (BPH). According to a new Indian study, HoLEP’s advantages include less bleeding and a shorter hospital stay, but the new procedure has a few drawbacks too.
The study, “Outcomes of transurethral resection and holmium laser enucleation in more than 60g of prostate: A prospective randomized study,” appeared in the journal Urology Annals. Overall, both procedures were successful in the study by doctors at King George’s Medical University in Lucknow, in the state of Uttar Pradesh.
When medical treatment for enlarged prostates fails, men often need surgery — and the current “gold standard” for such surgery is transurethral resection of prostate (TURP). But this more invasive treatment has significant complications, ranging from blood loss to post-operative urine retention (dysuria). With improvement in laser capabilities and surgeon training, doctors are looking at alternatives including holmium laser enucleation of prostate (HoLEP) — a minimally invasive surgery that enables a complete resection of the prostate to treat BPH, regardless of the patient’s prostate volume.
To compare both long- and short-term outcomes associated with these surgical procedures, researchers studied 144 BPH patients who had responded poorly or not at all to medical therapy. They divided
The men were divided into two groups: those treated with TURP (mean age of about 67; mean prostatic volume of 74.5 grams) and those who underwent HoLEP (mean age of about 68; mean prostatic volume of 75.6 grams). Follow-up analyses were done out at one, three and six months, and again at one and two years after the surgery.
Overall, the TURP procedure took about 73 minutes and HoLEP about 90 minutes — a difference the team considered significant but reasonable. Three TURP patients also needed post-surgery blood transfusions due to a drop in hemoglobin levels (below 8 g/dl), while no HoLEP patients did, possibly due to “the excellent hemostatic property of holmium laser,” the researchers wrote.
Doctors found no significant changes in sexual function in either group during follow-up analyses, nor were there any serious complications. Both procedures also seemed successful, with significant improvement noted in urine storage and release at six months.
Overall, HoLEP-treated men had less blood loss, lower transfusion rates and shorter hospital stays. However, this procedure took longer and sometimes led to painful urination after surgery, although this problem went away after six months of “conservative” treatment.