Benign Prostatic Hyperplasia (BPH) is a common condition affecting older men, characterized by an enlarged prostate gland that can cause urinary difficulties. Two prevalent surgical treatments for BPH are Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TUR-P).

HoLEP is a minimally invasive laser procedure that enucleates prostate tissue, which is then removed from the bladder. It offers advantages such as reduced bleeding, shorter hospital stays, and suitability for larger prostates. TUR-P, considered the gold standard for many years, involves the resection of prostate tissue using an electric loop. This procedure is well-established and effective but may have a higher risk of complications like bleeding and longer recovery times.

Comparing HoLEP and TUR-P involves evaluating factors such as efficacy, safety, recovery time, and patient outcomes to determine the most suitable option for treating BPH.

Comparison of HoLEP and TUR-P

A detailed comparison of Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TUR-P) for the treatment of Benign Prostatic Hyperplasia (BPH) involves examining various aspects including procedural differences, efficacy, safety, recovery, and patient outcomes.

Procedural Differences

HoLEP:

• Technique: Utilizes a holmium laser to enucleate the prostate tissue, which is then morcellated and removed from the bladder.
• Duration: Can be longer due to the enucleation and morcellation steps.
• Anesthesia: Typically requires general or spinal anesthesia.

TUR-P:

• Technique: Involves resecting prostate tissue using an electric loop through a resectoscope inserted into the urethra.
• Duration: Generally shorter than HoLEP.
• Anesthesia: Usually performed under general or spinal anesthesia.

Efficacy

HoLEP:

• Long-term Results: Provides durable relief of BPH symptoms with low retreatment rates.
• Prostate Size: Effective for small to very large prostates.
• Symptom Improvement: Significant improvement in urinary flow rates and symptom scores.

TUR-P:

• Long-term Results: Also offers durable relief, but with a slightly higher retreatment rate compared to HoLEP.
• Prostate Size: Best suited for small to moderate-sized prostates.
• Symptom Improvement: Similar significant improvement in urinary flow rates and symptom scores.

Safety

HoLEP:

• Bleeding: Lower risk of intraoperative and postoperative bleeding due to precise laser cutting and coagulation.
• Complications: Lower risk of complications like TUR syndrome (fluid absorption issues) and postoperative clot retention.

TUR-P:

• Bleeding: Higher risk of bleeding which can necessitate blood transfusions.
• Complications: Risk of TUR syndrome and other complications like clot retention and urethral strictures.

Recovery

HoLEP:

• Catheterization: Typically shorter catheterization time (12-24 hours).
• Hospital Stay: Shorter hospital stay, often 1-2 days.
• Recovery Time: Quicker return to normal activities and lower incidence of temporary urinary incontinence.

TUR-P:

• Catheterization: Longer catheterization time (2-3 days).
• Hospital Stay: Generally requires a longer hospital stay (2-3 days).
• Recovery Time: Longer recovery period with higher incidence of temporary urinary incontinence.

Patient Outcomes

HoLEP:

• Symptom Relief: High and sustained symptom relief with improved quality of life.
• Sexual Function: Lower risk of impacting sexual function, though retrograde ejaculation is common.
• Durability: Low retreatment rates.

TUR-P:

• Symptom Relief: High and sustained symptom relief with improved quality of life.
• Sexual Function: Higher risk of impacting sexual function, including retrograde ejaculation.
• Durability: Slightly higher retreatment rates compared to HoLEP.

Both HoLEP and TUR-P are effective surgical treatments for BPH, providing significant symptom relief and improved quality of life. HoLEP offers advantages in terms of reduced bleeding, shorter recovery time, and suitability for larger prostates. TUR-P, while well-established and effective, has a higher risk of complications and longer recovery periods. The choice between the two procedures should be based on patient-specific factors, including prostate size, overall health, and surgeon experience.

Comparison of interms of side effects

Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP) are two common surgical treatments for Benign Prostatic Hyperplasia (BPH). Each procedure has its own set of potential complications and benefits. Here is a detailed comparison of the complications associated with both HoLEP and TURP:

Bleeding

• HoLEP: Typically associated with less intraoperative and postoperative bleeding due to the laser’s ability to coagulate blood vessels during the procedure.
• TURP: Higher risk of bleeding because it involves cutting tissue with an electric loop, which can lead to significant blood loss, especially in patients with larger prostates.

Transfusion Rates

• HoLEP: Lower transfusion rates compared to TURP due to reduced bleeding.
• TURP: Higher transfusion rates are observed due to the greater likelihood of significant blood loss.

Operative Time

• HoLEP: Generally has a longer operative time, especially for larger prostates, due to the meticulous nature of the enucleation process.
• TURP: Usually shorter operative time for smaller prostates, but can be prolonged for larger prostates.

Hospital Stay

• HoLEP: Patients often have shorter hospital stays due to less postoperative bleeding and quicker recovery.
• TURP: Patients may have longer hospital stays, particularly if complications like bleeding or TURP syndrome occur.

Catheterization Time

• HoLEP: Typically shorter catheterization time as patients recover faster from the procedure.
• TURP: Longer catheterization times might be necessary due to postoperative bleeding and risk of clot retention.

TURP Syndrome

• HoLEP: Does not carry a risk of TURP syndrome since no large volumes of irrigation fluid are used.
• TURP: Risk of TURP syndrome, a potentially life-threatening condition caused by the absorption of irrigation fluids.

Urinary Incontinence

• HoLEP: Temporary urinary incontinence is more common postoperatively but usually resolves within a few weeks to months. Persistent incontinence is rare.
• TURP: Lower rates of temporary incontinence, but risk of persistent incontinence exists, though it is generally low.

 Sexual Dysfunction

• HoLEP: Retrograde ejaculation is common, but erectile dysfunction rates are low and comparable to TURP.
• TURP: Also commonly results in retrograde ejaculation. Erectile dysfunction rates are similar to those of HoLEP.

Stricture Formation

• HoLEP: Lower rates of urethral stricture and bladder neck contracture.
• TURP: Higher rates of urethral strictures and bladder neck contractures compared to HoLEP.

Reoperation Rates

• HoLEP: Very low reoperation rates due to complete removal of adenomatous tissue.
• TURP: Higher reoperation rates in the long term because of the potential regrowth of residual prostate tissue.

Summary

Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TUR-P) are two prominent surgical treatments for Benign Prostatic Hyperplasia (BPH).

HoLEP uses a holmium laser to enucleate and remove prostate tissue, offering advantages such as reduced bleeding, shorter hospital stays, and suitability for larger prostates. It also results in quicker recovery and lower retreatment rates.

TUR-P involves resecting prostate tissue with an electric loop, which is effective and well-established but comes with higher risks of bleeding, longer recovery times, and complications like TUR syndrome.

Both procedures provide significant symptom relief and improved quality of life, but the choice between them depends on factors like prostate size, patient health, and surgeon expertise.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE