LAUSR

OBJECTIVE To evaluate efficacy and safety of holmium laser enucleation of the prostate (HoLEP), bipolar enucleation of the prostate (bTUEP) and transurethral resection of the prostate (TURP) in medium-sized prostates (50cc). METHODS We present a retrospective analysis of 2230 patients treated for lower urinary tract symptoms. We analysed perioperative parameters, short-term clinical outcomes and adverse events in matched-pair cohorts. RESULTS Both HoLEP and bTUEP were superior in terms of efficacy compared to TURP (surgery time: 51min and 50min vs. 60min; p < 0.001; tissue retrieval percentage: 71.4% and 70% vs. 50%; p < 0.001) and showed stronger improvement of LUTS (change IPSS: -15 and -14 vs. -10; p = 0.008). Furthermore, urodynamic parameters (Qmax: +15 ml/s and +19 ml/s vs. +12 ml/s; p < 0.001; PVR: -100 ml and -95 ml vs. - 80ml; p < 0.008) were significantly more improved after enucleation than after TURP. All techniques showed an equally low complication rate (6.9% and 6.9% vs. 10.3%; p = 0.743). No relevant difference of clinical outcomes was identified between HoLEP and bTUEP. CONCLUSIONS Both resection and enucleation are efficient and safe procedures in patients with medium-sized prostates (50cc), but irrespective of the technical approach, transurethral enucleation is superior to TURP in terms of perioperative and functional outcomes.