Surgical treatment of benign prostatic hyperplasia: Thulium enucleation versus single-port transvesical robotic simple prostatectomy.

OBJECTIVE

The objective of this work is to compare our outcomes using thulium laser enucleation of prostate (ThuLEP) to the single-port robot-assisted simple prostatectomy (SP RASP) in the surgical management of benign prostatic hyperplasia (BPH).

METHODS

A retrospective cohort study was conducted from January 2017 through December 2021 of men who underwent SP RASP and ThuLEP performed by a single surgeon with an enucleation experience of >300 cases and extensive robotic experience. The primary outcome was changed in International Prostate Symptom Score (IPSS) postoperatively. Secondary outcomes were operative time, length of stay (LOS), change in post-void residuals (PVR), de novo stress- or urge-urinary incontinence (SUI, UUI), and rate of complications.

RESULTS

One hundred two patients underwent surgery during the study period: 33 RASP and 69 ThuLEP. There was no difference in preoperative characteristics, including age and body mass index, between both groups. Changes in IPSS scores postoperatively were not significant between SP RASP versus ThuLEP (-17 vs. -14,  = 0.2956). SP RASP had a longer operative time (180 vs. 90 min,  < 0.0001). There was no difference in LOS (0 vs. 0 days,  = 0.2904). There was no difference in change in PVR (-96 vs. -91 mL,  = 0.8504). SP RASP patients had significantly less postoperative SUI than ThuLEP (0 vs. 13 patients,  = 0.0083), while there was no difference in UUI between both groups (4 vs. 2 patients,  = 0.0843). There was no difference in 30-day complication rate (21.2% vs. 21.7%,  = 0.9517), although there were three ThuLEP patients with Clavien-Dindo Class III or higher complication.

CONCLUSIONS

There was no difference in change in IPSS scores between the two groups. ThuLEP is associated with shorter postoperative catheter days and decreased operative times. Hospital LOS was equivalent. SP RASP demonstrates significantly improved continence rates. Though SP RASP is within the initial learning curve at our institution, early results demonstrate the role for this modality alongside ThuLEP in the treatment of large gland BPH.