To compare the perioperative outcomes of transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP).
A retrospective review was performed of patients undergoing SP-RASP and HoLEP from 2019-2022 with preoperative prostatic volume (PPV) >80cm. Percent of prostate adenoma removed (%PAR) was estimated by specimen weight normalized by PPV. Univariate analysis was performed using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests. A subgroup analysis with 1:1 matching for PPV was also performed.
A total of 50 SP-RASP and 90 HoLEP cases were analyzed. The median (IQR) PPV was 169 (128-244)cm for SP RASP and 129 (100-150)cm for HoLEP, (p<0.01). The median (IQR) %PAR was 57(44-68) for SP-RASP versus 51(42-62) for HoLEP (p=0.10). Overall, 11(12%) HoLEP and 5(10%) SP-RASP patients experienced complications (p=0.51). Same-day discharge occurred in 24(48%) SP-RASP versus 7(8%) HoLEP patients (p<0.01). Median foley catheter duration was longer in SP-RASP (6 vs 1 day, p 94% (p=0.68). Transient de-novo incontinence was reported in 24(28%) HoLEP versus 2(5%) SP-RASP (p<0.01). No differences in voiding parameters were observed at latest follow up. Subgroup post-matched analysis revealed analogous findings.
SP-RASP and HoLEP have similar favorable perioperative outcomes for management of large prostatic adenomas. SP-RASP may be considered in patients unwilling to accept the risk of transient incontinence and in those with unfavorable urethral access, large bladder stone burden, or diverticulae.
Copyright © 2023. Published by Elsevier Inc.
