Perioperative outcomes of HoLEP, ThuLEP, and TURP in patients with prostate cancer: results from the GRAND study.

BACKGROUND

Limited data exist on the role of holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), and transurethral resection of the prostate (TURP) in patients with prostate cancer (PCa). We aimed to analyze their perioperative outcomes and trends.

MATERIALS AND METHODS

The German Nationwide Inpatient Data (GRAND) registry was used to identify male patients diagnosed with PCa who underwent HoLEP, ThuLEP, or TURP between 2005 and 2022. Multivariable regression analyses were performed to compare perioperative morbidity and mortality.

RESULTS

A total of 221,768 procedures in patients with PCa were performed: 8160 HoLEP, 2285 ThuLEP, and 211,323 TURP. Although TURP remains the predominant technique, the use of HoLEP and ThuLEP has increased significantly in recent years, representing 17% of all cases by 2022. Perioperative outcomes were worse for TURP, with higher transfusion (8.8%) and ICU admission rates (1.7%) compared to HoLEP and ThuLEP (both 2.5% and ≤1.2%, respectively). Postoperative urinary retention and incontinence rates were also lower for laser enucleation techniques than TURP. In patients with PCa undergoing TURP, perioperative outcomes were worse compared to those without PCa, while outcomes for HoLEP and ThuLEP were comparable regardless of PCa status.

CONCLUSION

HoLEP and ThuLEP offer improved perioperative outcomes compared to TURP in patients with PCa.