Comparison of Efficacy of Different Surgical Techniques for Benign Prostatic Obstruction

• Published in: International neurourology journal Vol. 25; no. 3; pp. 252 - 262
• Main Authors: Yu, Jiwoong, Jeong, Byong Chang, Jeon, Seong Soo, Lee, Sung Won, Lee, Kyu-Sung
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Continence Society 01-09-2021; 대한배뇨장애요실금학회
• Subjects: benign prostatic hyperplasia; benign prostatic obstruction; holmium laser enucleation of prostate; laser vaporization prostatectomy; Original; transurethral resection of prostate; urinary bladder neck obstruction; 비뇨기과학; Benign prostatic hyperplasia; Urinary bladder neck obstruction; Laser vaporization prostatectomy; Benign prostatic obstruction; Transurethral resection of prostate; Holmium laser enucleation of prostate
• ISSN: 2093-4777; 2093-6931; 2093-6931
• DOI: 10.5213/INJ.2040314.157

We compared success rates of three surgical techniques [holmium laser enucleation of the prostate (HoLEP), transurethral resection of the prostate (TURP), and photoselective laser vaporization prostatectomy (PVP)] for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success.
A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (I-PSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, post-void residual urine, and I-PSS/QoL index were measured six months postoperatively. Surgical success was defined based on I-PSS, maximum flow rate (Qmax), and QoL index and predictive factors were identified using multiple logistic regression analyses.
Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥ 50 cc and bladder outlet obstruction index (BOOI) ≥ 40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated.
Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥ 50 cc and BOOI ≥ 40 were independent predictive factors for the success of HoLEP but not of TURP.