Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison

Alfredo Maria Bove, Aldo Brassetti, Mario Ochoa, Umberto Anceschi, Simone D'Annunzio, Marilia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Riccardo Mastroianni, Silvia Cartolano, Giulia Torregiani, Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Simone, Alfredo Maria Bove, Aldo Brassetti, Mario Ochoa, Umberto Anceschi, Simone D'Annunzio, Marilia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Riccardo Mastroianni, Silvia Cartolano, Giulia Torregiani, Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Simone

Abstract

Introduction: The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other.

Material and methods: The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement.

Results: We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016).

Conclusions: At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP.

Keywords: HOLEP; Trifecta; benign prostatic obstruction; functional outcomes; robot-assisted simple prostatectomy.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright by Polish Urological Association.

Figures

Figure 1
Figure 1
Trifecta rates in HOLEP and RASP groups. Trifecta was definied as Qmax >15 ml/sec, absence of complications and IPSS

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