SP-RASP and HoLEP have similar Outcomes for Prostatic Adenomas

In a recent study, Diego Aguilar Palacios and team assessed the perioperative outcomes of two minimally invasive surgical techniques for managing large prostatic adenomas: transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP) and found that both SP-RASP and HoLEP exhibit comparable favorable perioperative outcomes in the management of large prostatic adenomas. The findings were published in Urology Journal.

The study, conducted through a retrospective review of patients from 2019 to 2022, aimed to determine the advantages and disadvantages of each procedure for treating benign prostatic hyperplasia (BPH). They included a total of 50 patients who underwent SP-RASP and 90 patients who underwent HoLEP. All patients had preoperative prostatic volumes (PPV) greater than 80cm3. To estimate the percent of prostate adenoma removed (%PAR), researchers used the specimen weight normalized by the PPV. Univariate analysis was performed using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests, and a subgroup analysis with 1:1 matching for PPV was also conducted.

The findings revealed that the median PPV for SP-RASP was significantly higher than that of HoLEP (169cm3 vs. 129cm3, p<0.01). However, there was no significant difference in the median %PAR between the two techniques (57% for SP-RASP vs. 51% for HoLEP, p=0.10). Additionally, the overall rate of complications was similar in both groups, with 12% of HoLEP patients and 10% of SP-RASP patients experiencing complications (p=0.51).

One notable disparity was observed regarding same-day discharge rates, with 48% of SP-RASP patients discharged on the same day of the surgery compared to only 8% of HoLEP patients (p<0.01). The duration of foley catheter usage was also longer in SP-RASP patients, lasting six days on average, while HoLEP patients used the catheter for only one day (p<0.01). However, the success rate of the trial of void at the first attempt was similar in both groups, exceeding 94% (p=0.68).

Transient de-novo incontinence, although reported in both groups, occurred more frequently in HoLEP patients (28%) compared to SP-RASP patients (5%) (p<0.01). However, there were no significant differences in voiding parameters at the latest follow-up.

Source:

Palacios, D. A., Kaouk, J., Zeinab, M. A., Ferguson, E. L., Abramczyk, E., Wright, H. C., Pramod, N., & De, S. (2023). Holmium Laser Enucleation of the Prostate Versus Transvesical Single-Port Robotic Simple Prostatectomy for Large Prostatic Glands. In Urology. Elsevier BV. https://doi.org/10.1016/j.urology.2023.07.020