A single-centre assessment of short-term functional outcomes of holmium laser enucleation vs. robot-assisted simple prostatectomy for medium and large-volume benign prostatic hyperplasia.

INTRODUCTION

The objective of the study was to compare short-term functional outcomes and quality of life (QoL) between robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) in patients undergoing surgery for medium and large-volume benign prostatic hyperplasia (BPH) in our centre.

MATERIAL: In this retrospective study based on a prospectively maintained database, we included all consecutive patients treated with RASP or HoLEP at our centre between September 2021 and November 2023. Standardized questionnaires were administered preoperatively and at 6 and 20weeks postoperatively: IPSS with QoL item, Urinary Symptom Profile (USP) which includes stress urinary incontinence (SUI), overactive bladder (OAB) and dysuria assessment, as well as IIEF-5 score.

RESULTS

Among 161 patients who underwent surgery (144 HoLEP, 17 RASP), only 71 (44%) completed all questionnaires (56 HoLEP, 15 RASP). This study focuses on these 71 patients. Except for prostate volume, which was higher in the RASP group (159mL vs 85.5mL, P<0.01), baseline characteristics and functional scores were comparable. At 20weeks, median IPSS scores were similar (5 vs 2, P=0.57), but median QoL scores favoured RASP (0 vs 1, P=0.04). RASP was associated with lower stress incontinence at both 6 and 20weeks (USP SUI scores 4 vs 0, P=0.01 and 2 vs 0, P=0.01, respectively), and less overactive bladder at 6weeks (USP OAB at 6weeks 10 vs 7, P=0.04). Postoperative IIEF-5 scores and maximal urinary flow rates were not significantly different between groups.

CONCLUSIONS

Despite significant methodological limitations (selection and attrition biases, small sample size, and severe imbalance between groups), RASP may be associated with better early outcomes, particularly regarding continence and overactive bladder symptoms. These findings are limited by a questionnaire completion rate of 44% and a 20-week follow-up.