Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results From a 2-Center Prospective Randomized Trial in Patients With Obstructive Benign Prostatic Hyperplasia

Purpose: To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. Materials and Methods: From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. Results: At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room ± SD was significantly longer than for TURP (74 ± 19.5 vs 57 ± 15 minutes, p <0.05), while catheterization time (31 ± 13 vs 57.78 ± 17.5 minutes, p <0.001 and hospital stay (59 ± 19.9 vs 85.8 ± 18.9 hours, p <0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. Conclusions: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups. © 2008 American Urological Association.