Comparison Between HoLEP and PUL in Management of BPH
Comparison Between HoLEP and PUL in Management of BPH
Comparison between two minimally invasive surgical modalities in management of Benign
 Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms
 (LUTS) in aging men. LUTS is categorized as any combination of symptoms related to storage,
 voiding, or postmicturition. The management of bothersome BPH includes watchful waiting,
 pharmacotherapy, and surgery. The most common surgical approach is transurethral resection of
 the prostate (TURP). TURP can improve voiding symptoms dramatically. However, TURP is
 correlated with a 20% rate of perioperative and long-term complications. In addition, elderly
 patients usually have some comorbidities that require complex medical regimens that may
 further complicate perioperative management. Therefore, new treatments that are more
 minimally invasive and more effective are needed to manage patients with LUTS.The advent of
 Holmium laser enucleation of the prostate (HoLEP) has triggered a paradigm shift in the
 surgical management of BPH; with improved functional outcomes, lower complication rates and
 length of stay, and fewer repeat procedures required at 5- 10 years versus TURP, and open
 prostatectomy. HoLEP is now regarded as the gold standard for BPH.Prostatic urethral lift
 (PUL) is a minimally invasive surgery that uses small implants under cystoscopic guidance
 which serve to retract the obstructing lateral lobes and make an open, continuous voiding
 channel through the prostate fossa, from the verumontanum up to the bladder neck. PUL has
 been demonstrated to provide significant symptom improve with low morbidity, including
 preservation of sexual function.
Inclusion Criteria:

 -  Age ˃ 50 years.

 -  Prostate volume 20-70 mL (on ultrasound).

 -  IPSS(International Prostate Symptom Score) ˃ 12.

 -  Qmax(Peak Flow Rate) ˂ 15 mL/s.

 -  PVR(post-void residual urine) ˂ 350 mL

 Exclusion Criteria:

 -  Obstructive median lobe.

 -  Active urinary tract infection.

 -  PSA (Prostate Specific Antigen) ˃ 10 ng/mL (unless negative prostatic biopsy).

 -  Prostatitis within past 1 year.

 -  History of urinary retention

 -  Previous BPH surgery.