HoLEP Vs BPEP for Large Prostatic Adenoma
HoLEP Vs BPEP for Large Prostatic Adenoma
Benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly
 males. The symptoms of BPH include impaired physiological and functional well-being, which
 interferes with daily living.

 At present, transurethral resection of the prostate (TURP) is the standard surgical
 treatment. However, the high rate of complications associated with TURP is a major drawback
 of this procedure.

 Holmium laser enucleation of the prostate (HoLEP) was proven to be an effective surgical
 treatment for BPH with no prostate size limitation with adequate hemostasis, bipolar
 enucleation of the prostate (BPEP) has been introduced as an alternative energy source with a
 promising outcome with equal safety and efficacy
Enlarged prostate represents the most common cause of lower urinary tract symptoms (LUTS) in
 elderly men including irritative, obstructive urinary symptoms or even urinary retention that
 significantly affects the quality life (QoL).

 Transurethral resection of the prostate (TURP) represents the standard surgical technique for
 the management of benign prostatic hyperplasia (BPH) with a prostate size less than 80 ml.
 However, considerable morbidities are associated with larger sizes.

 Endoscopic enucleation of the prostate (EEP) has been recognized as a treatment option for
 large prostatic adenomas, since first described by Hiraoka et.al, in 1986, it started to gain
 popularity despite the long learning curve. Many studies have evaluated its efficacy against
 the gold standard open prostatectomy in large prostate size more than 80ml and showed its
 safety and efficacy.

 EEP represents an anatomical surgical technique resembling a surgeon's finger in open
 prostatectomy where any energy source that provides adequate haemostasis could be used. Many
 studies concluded that EEP relies on the surgeon's skills rather than the energy source
 itself. Holmium laser enucleation of the prostate (HoLEP) was first described by Gilling in
 1998 and was proven to be effective with no prostate size limitation with adequate
 haemostasis, recently it has been approved as a standard treatment for large prostatic
 adenoma, bipolar enucleation of the prostate (BPEP) has been introduced as an alternative
 energy source with a promising outcome with equal safety and efficacy.

 Few studies evaluated both techniques, one study was done by Shoma et al. showing no
 statistical difference regarding safety and efficacy between both techniques, another study
 conducted by Enikeev et al. reported earlier recovery and catheter removal with HoLEP
 compared to BPEP. However, cost-effectiveness was never been evaluated before between both
 techniques especially in developing countries.

 With such scarce information, the investigators aimed through this study to compare these two
 energy sources in the enucleation procedure of the prostate in terms of safety, efficacy, and
 cost-effectiveness in the management of BPH in large prostatic adenoma more than 80 ml.
Inclusion Criteria:

 -  Men who are fit for surgery and need a surgical resection of the prostate larger than
 80 ml including:

 1. Bothersome LUTS with an IPSS score over 19

 2. Refractory hematuria

 3. Upper urinary tract affection

 4. Recurrent UTI secondary to prostatic enlargement

 5. Maximum uroflow rate (Qmax) below 10 ml/sec.

 6. bladder diverticula

 7. Urinary retention whether recurrent acute attacks with failure of medical
 treatment or chronic retention.

 Exclusion Criteria:

 -  Patients with:

 1. Neurogenic bladder

 2. Previous prostate or urethral surgery

 3. Associated urethral stricture

 4. Prostate cancer diagnosed by TRUS biopsy

 5. Bladder stones,