Presented by: Carl A Ceraolo MD, MPH
University of Rochester Medical Center, Department of Urology

Introduction

Holmium Laser Enucleation of the Prostate (HoLEP) and Robot assisted Simple Prostatectomy (RASP) are standard of care for management of large gland (>80cc) benign prostatic hyperplasia (BPH). RASP can be performed using a traditional multiple port suprapubic approach (MP-RASP) or more recently a single port approach (SP-RASP).  This retrospective study aims to compare RASP surgical and postoperative metrics across approaches with HoLEP at a single institution.

Materials

Data were queried from a consented and prospectively maintained database for patients with large gland (>80cc) BPH who underwent HoLEP between January 2022 and March 2023 at a single institution.  Data were also retrospectively queried by manual chart review for patients with large gland BPH who underwent RASP in the same time period. Variables were analyzed using median and interquartile ranges for continuous variables, and proportions were obtained for count data. The Kruskal- Wallis test was used to compare continuous variables among RASP and HoLEP, and sub-analyses were performed comparing RASP approaches with HoLEP. A chi-square test was used to compare count data, and the fisher exact test was used for low count data. Linear regression was performed to obtain unadjusted and adjusted mean differences. P-values were reported with a pre-determined alpha of 0.05. Statistical analyses were performed with R version 4.3.0.

Results

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The study included 74 patients who underwent HoLEP and 30 patients who underwent RASP, of which 16 underwent SP-RASP and 14 underwent MP-RASP. Baseline, operative, and outcome analyses are reported in Table 1. Preoperative metrics were not significantly different among surgical groups except for prostate size. Operative time and catheter duration were greater in RASP groups compared to HoLEP (p < 0.05) in both tabular analysis and linear regression.

Conclusion

This study contributes to literature comparing HoLEP with RASP and is one of the first studies comparing HoLEP with SP-RASP. Notably, our practice tends to send larger prostates for RASP. However, catheter duration, OR time, and hematuria were greater with RASP across approaches. Outcomes were favorable for all groups.

Funding

None

Lead Authors

Scott O Quarrier, MD, MPH
University of Rochester Medical Center, Department of Urology

Co-Authors

Karen M Doersch, MD, PhD
University of Rochester Medical Center, Department of Urology

Anthony J Pamatmat, BS
University of Rochester School of Medicine and Dentistry

Laena T Hines, MD
University of Rochester Medical Center, Department of Urology

Jodi Erler, LPN, MHA
University of Rochester Medical Center, Department of Urology

Thomas P Frye, DO
University of Rochester Medical Center, Department of Urology

Guan Wu, MD, PhD
University of Rochester Medical Center, Department of Urology

Hani H Rashid, MD
University of Rochester Medical Center, Department of Urology

Ahmed Ghazi, MD, MSc
University of Rochester Medical Center, Department of Urology

Jean V Joseph, MD, MBA
University of Rochester Medical Center, Department of Urology

Rajat K Jain, MD
University of Rochester Medical Center, Department of Urology