Low-Power Vs High-Power Holmium Laser Enucleation of the Prostate: Critical Assessment through Randomized Trial

To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. HoLEP was performed using 10...

Full description

Saved in:
Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2018-11, Vol.121, p.58-65
Main Authors: Elshal, Ahmed M., El-Nahas, Ahmed R., Ghazy, Mostafa, Nabeeh, Hossam, Laymon, Mahmoud, Soltan, Mohamed, Ghobrial, Fady K., EL-Kappany, Hamdy A.
Format: Article
Language:English
Subjects:
Aged
Dysuria - diagnosis
Dysuria - etiology
Dysuria - psychology
Humans
Laser Therapy - adverse effects
Laser Therapy - instrumentation
Laser Therapy - methods
Lasers, Solid-State - therapeutic use
Male
Middle Aged
Postoperative Complications - diagnosis
Postoperative Complications - psychology
Prostate - diagnostic imaging
Prostate - pathology
Prostate - surgery
Prostatic Hyperplasia - diagnosis
Prostatic Hyperplasia - psychology
Prostatic Hyperplasia - surgery
Quality of Life
Sexual Dysfunction, Physiological - diagnosis
Sexual Dysfunction, Physiological - etiology
Sexual Dysfunction, Physiological - psychology
Transurethral Resection of Prostate - adverse effects
Transurethral Resection of Prostate - instrumentation
Transurethral Resection of Prostate - methods
Treatment Outcome
Visual Analog Scale
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, P = .6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (P = .4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, P = .92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience. •LP-HoLEP; Low-power Holmium laser enucleation of the prostate•HP-HoLEP; High-power Holmium laser enucleation of the prostate•LUTS; Lower urinary tract symptoms•BPH; Benign prostate hyperplasia
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2018.07.010