The outcomes of top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): A randomized prospective comparative study
Waleed Shabana1, Abdulrhman Ahmed1, Fabiola Oquendo1, Amr Hodhod1, Thomas Tablowski1, Shalyn Littlefield1, Ahmed Kotb1, Walid Shahrour1, Hazem Elmansy1.
1Northen Ontario School Of Medicine, Thunder Bay, ON, Canada
Introduction: Top-down Holmium Laser Enucleation of the Prostate (HOLEP) was recently introduced as a safe and effective modification of traditional HoLEP. We aim to compare intraoperative and postoperative outcomes of the top-down technique with traditional HoLEP for the treatment of BPH.
Methods: Sixty-eight patients participated in this randomized controlled trial. All procedures were performed by a single surgeon experienced with both HoLEP techniques (HE). Patients were followed-up at 1, 3, and 6 months. Outcome measures including IPSS, QoL, flow rate, PVR, IIEF-15, ICIQ-SF, PSA and TRUS prostate volume changes were collected and compared. Perioperative complications were also recorded.
Results: There was no statistically significant difference between both groups with regards to perioperative data including age, TRUS prostate volume, IPSS, QoL, IIEF-15, ICIQ-SF and preoperative PSA. Both techniques significantly improved postoperative parameters immediately after surgery and continued the entire follow up period. There was no statistical difference in enucleation time. Although stress urinary incontinence was statistically insignificant, there was a trend to a lower percentage in the top-down group (table1).
Conclusions: The HoLEP procedure significantly improves patients’ urinary functions, regardless of the approach
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