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Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g.

Methods

One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months.

Results

There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months.

Conclusions

The HoLEP procedure significantly improves patients’ urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

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Fig. 1: Study flowchart.

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Data availability

The data that support the findings of this study are available from the corresponding author, HE, upon a reasonable request.

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Author information

Authors and Affiliations

  1. Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada

    Hazem Elmansy, Loay Abbas, Moustafa Fathy, Amr Hodhod, Waleed Shabana, Abdulrahman Alkandari & Walid Shahrour

  2. Urology Department, Theodor Bilharz Research Institute, Giza, Egypt

    Loay Abbas & Mamdouh A. Roshdy

  3. Urology Department, Cairo University, Cairo, Egypt

    Enmar Habib & Alaa Meshref

Authors
  1. Hazem Elmansy
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  2. Loay Abbas
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  3. Moustafa Fathy
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Contributions

HE: Protocol/project development and manuscript writing. LA: Protocol development and manuscript writing. MF: Data collection and management. AH: Statistical analysis and manuscript editing. WS: Manuscript editing. AA: Manuscript writing. EH: Protocol development and manuscript editing. AM: Manuscript editing. MR: manuscript editing. WS: Manuscript editing.

Corresponding author

Correspondence to Hazem Elmansy.

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The authors declare no competing interests.

Ethical and consent statement

The study was approved by Thunder Bay Regional Health Sciences Centre’s Research Ethics Board (TBRHSC REB # 2019518). Informed consent was obtained from all patients. The study was performed in accordance with the Declaration of Helsinki.

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Elmansy, H., Abbas, L., Fathy, M. et al. Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00730-x

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