HoLEP vs mTURP in Management of Benign Prostatic Hyperplasia
HoLEP vs mTURP in Management of Benign Prostatic Hyperplasia
To compare the clinical outcome regarding safety and efficacy between Holmium laser
 enucleation of the prostate and transurethral resection of the prostate in management of
 benign prostatic hyperplasia.
Benign prostatic hyperplasia (BPH) affects 70% of men older than 70 years and is a
 significant cause of morbidity in this population.

 The symptoms of BPH include impaired physiological and functional well-being, which
 interferes with daily living.

 Lower urinary tract symptoms (LUTS) in elderly men are mainly related to an enlarged
 prostate, the actual link between an enlarged prostate and the onset of symptoms are
 multifactorial.

 LUTS include both irritative symptoms in the form of urgency, frequency, nocturnal enuresis
 and urge incontinence as well as obstructive symptoms comprise hesitancy, weak interrupted
 stream of urine, incomplete voiding which eventually affect the quality of life (QoL), the
 main goal of treatment is resolve these symptom.

 Multiple surgical options are available for management of benign prostatic hyperplasia (BPH)
 and its associated symptoms. Transurethral resection of the prostate (TURP) and open
 prostatectomy remain the gold standard surgical management. However, considerable morbidities
 are associated with both procedures and mainly related to the prostate size.

 These complications may be either patient or surgically related. The patient's related
 complications are cardiac arrhythmia, myocardial infarction, pulmonary embolism, exacerbation
 of previous respiratory disease, deep venous thrombosis and death. The surgical related
 complication includes bleeding, capsular perforation, urosepsis, incontinence, conversion to
 open surgery, bladder neck stenosis, redo surgery and transurethral resection syndrome.

 Clearly, a wide gap existed between simple medical therapy on one hand and TURP on the other
 hand. This wide gap is coupled with the need for a less morbid alternative to TURP that led
 to the emergence of various less invasive therapy among which Laser based minimally invasive
 procedure.

 Modern laser therapy for BPH has advantages over TURP including decreased blood loss and
 minimal serum electrolyte changes resulting in fewer cardiovascular complications, decreased
 catheter time, shorter hospital stay and the ability to treat patients on anticoagulation.

 Because of these potential advantages, there has been a shift in practice patterns with laser
 procedures accounting for 57% of surgical interventions for BPH, compared to traditional TURP
 which accounted for only 39% of interventions in 2005.

 Holmium laser enucleation of the prostate (HoLEP) is the most recent step in the evolution of
 holmium laser prostatectomy. HoLEP is a safe and effective surgical procedure, which has
 comparable results to transurethral resection of the prostate (TURP) and open prostatectomy,
 with low morbidity and short hospital stay.

 HoLEP is equally suitable for small, medium, and large prostate glands, with clinical
 outcomes that are independent of prostate size, and recently it has been proposed as a new
 gold standard for treatment of symptomatic benign prostatic hyperplasia (BPH). Currently, all
 BPH guidelines recommend HoLEP as a surgical treatment of BPH.

 For a procedure to be considered a gold standard, it must provide effective results, low
 morbidity, and durable outcomes. HoLEP, as many of the new alternative treatments for
 symptomatic BPH, has scanty data regarding its role in Egyptian population and if it can
 replace TURP to be the gold standard.

 To our best knowledge, no one estimated cost effectiveness between the two techniques in a
 developing country.

 Our study aimed to compare the efficacy, safety and cost effectiveness of HoLEP versus
 monopolar TURP in management of benign prostatic hyperplasia in a developing country.
Inclusion Criteria:

 -  prostate volume less than 80 ml

 -  high IPSS more than 19 affecting quality of life

 -  recurrent urinary retention with failure of medical treatment

 -  recurrent urinary tract infection

 -  affection of upper urinary tract

 -  refractory hematuria

 -  bladder stones

 -  bladder diverticula

 Exclusion Criteria:

 -  patients with neurogenic bladder

 -  patients with previous prostate or urethral surgery

 -  associated urethral stricture

 -  prostate cancer diagnosed by TRUS biopsy

 -  prostate volume more than 80 ml