Presented by: Vladislav Petov urologist, researcher
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Introduction

According to the current EAU guidelines, the main methods of surgical treatment for patients with large benign prostate hyperplasia (BPH) (>80 cc) are endoscopic enucleation (EEP) and open simple prostatectomy. An alternative method of treatment is minimally simple prostatectomy (MISP; laparoscopic/robotic). To date, there are few studies demonstrating its effectiveness.

The aim of the study is to compare the perioperative results of EEP and MISP in patients with large BPH

Materials

A retrospective study was conducted from 2020 to 2023. We enrolled patients, who underwent one of the following interventions: thulium fiber laser EEP (ThuFLEP), laparoscopic or robotic MISP (l-MISP, r-MISP). Inclusion criteria: severe lower urinary tract symptoms (IPSS> 20) and/or Qmax <15 ml/sec and prostate volume >120 cc. The operations were compared in terms of efficiency and safety. The effectiveness was assessed by the duration of the operation, the mass of the removed tissue, resection rate; safety - by the level of hemoglobin drop, complications rate (according to Clavien-Dindo). The duration of catheterization and hospitalization was also evaluated.

Results

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The analysis included data of 268 patients (ThuFLEP – 225, l-MISP – 33, r-MISP – 10 patients, respectively). The groups did not differ in age (p=0.6), residual urine volume (p=0.5), Qmax (p=0.93), and IPSS score (p=0.05). A statistically significant difference was found in relation to prostate volume (ThuFLEP – 161±89 cc, l-MISP – 205±48 cc, r-MISP – 183±60 cc; p <0.01). The duration of the operation was significantly longer in the MISP groups (ThuFLEP -102±35 min, l-MISP – 146±52 min, r-MISP – 165±73 min; p <0.01). At the same time, the mass of the removed tissue did not differ (ThuFLEP – 121±31 g, l-MISP – 139±34 g, r-MISP – 130±46 g; p =0.10). The resection rate is higher during enucleation (ThuFLEP -1.2± 0.4 g/min, l-MISP- 0.98±0.34 g/min, r-MISP- 0.77±0.44 g/min; p=0.04). The hemoglobin drop did not differ (p =0.29), however, the frequency of hemotransfusions was higher with LPR-A (ThuFLEP and r-MISP– 0%, l-MISP- 15.5%; p <0.01). The frequency of other complications of Clavien-Dindo ≤ II is also significantly lower in the ThuFLEP group (p=0.01), while the frequency of Clavien-Dindo ≥ III is comparable (p=0.99). Additional interventions (cystolithotomy, hernioplasty, vasectomy, diverticulectomy) were more often performed with MISP (ThuFLEP – 4%, l-MISP– 51%, r-MISP– 30%; p <0.01). The duration of catheterization, as well as hospitalization, is significantly lower with ThuFLEP (p <0.01).

Conclusion

In general, ThuFLEP demonstrates efficiency comparable with MISP in treatment of patients with large BPH. Despite the fact that ThuFLEP is considered more safety, probably MISP might be preferable in the presence of severe concomitant pathology (multiple stones, inguinal hernia, diverticula etc.), because it allows to treat both conditions via single surgical access.

Funding

the study is deprived of funding

Lead Authors

Leonid Rapoport, M.D., PhD, Prof
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Co-Authors

Ekaterina Timofeeva, student
Sklifosovsky Institute for Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University)

Andrey Bazarkin,
Sklifosovsky Institute for Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University)

Mark Taratkin, M.D., urologist, researcher
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Michael Enikeev,
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Evgeny Bezrukov,
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Roman Sukhanov,
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Evgeny Shpot,
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)

Alim Dymov,
Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University)