Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? HoLEP has been widely adopted worldwide as an alternative to TURP but long term results have been lacking despite the strong scientific basis for the technique. This study provides long‐term results from the original RCT comparing the two techniques. OBJECTIVE To assess the durability of holmium laser enucleation of prostate in comparison to transurethral resection of the prostate (TURP). PATIENTS AND METHODS Patients were enrolled in the present study between June 1997 and December 2000 and followed per protocol. All patients were urodynamically obstructed with a prostate volume of between 40 and 200 mL. At long‐term follow‐up, variables assessed included Benign Prostatic Hyperplasia Impact Index (BPHII), International Continence Society Short Form Male questionnaire (ICSmale‐SF) and the International Index of Erectile Function (IIEF). Adverse events, including the need for retreatment, were specifically assessed. RESULTS Thirty‐one (14 holmium laser enucleation of the prostate [HoLEP] and 17 TURP) of the initial 61 patients were available, with 12 deceased and 18 lost to follow‐up. The mean (range) follow‐up was 7.6 (5.9–10.0) years and the mean (± sd ) age at follow‐up was 79.8 (±6.2) years. The mean (± sd ) values (HoLEP vs TURP) were as follows: maximum urinary flow rate ( Q max ), 22.09 ± 15.47 vs 17.83 ± 8.61 mL/s; American Urological Association (AUA) symptom score, 8.0 ± 5.2 vs 10.3 ± 7.42; quality of life (QOL) score 1.47 ± 1.31 vs 1.31 ± 0.85; BPHII, 1.53 ± 2.9 vs 0.58 ± 0.79; IIEF‐EF (erectile function), 11.6 ± 7.46 vs 9.21 ± 7.17; ICSmale Voiding Score (VS), 4.2 ± 3.76 vs 3.0 ± 2.41; ICSmale Incontinence Score (IS), 3.07 ± 3.3 vs 1.17 ± 1.4. There were no significant differences in any variable between the two groups beyond the first year. Of the assessable patients, none required re‐operation for recurrent BPH in the HoLEP arm and three (of 17) required re‐operation in the TURP arm . CONCLUSION The results of this randomized trial confirm that HoLEP is at least equivalent to TURP in the long term with fewer re‐operations being necessary.