Comparison of Holmium Laser Enucleation of the Prostate with Bipolar Plasmakinetic Enucleation of the Prostate: A Randomized, Prospective Controlled Trial at Midterm Follow-Up

Objective: To compare the clinical efficacy and safety of holmium laser enucleation of the prostate (HoLEP) with bipolar plasmakinetic enucleation of the prostate (BPEP) in the surgical management of obstructive benign prostatic hyperplasia (BPH) at midterm (minimum 3 years) follow-up.Patients and Methods: Between June 2016 and January 2018, 181 patients who had bothersome lower urinary tract symptoms or refractory retention of urine due to obstructive BPH (prostate 32-128 g) were randomized to undergo either HoLEP or BPEP using the en bloc technique. Patient's age, associated comorbidities, baseline International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR) urine, and quality of life (QoL) scores were comparable in both groups. From each group, 86 patients who completed regular follow-up for 36 months were analyzed.Results: The mean preoperative prostate volume was comparable in both groups (HoLEP group 61.09 +/- 28.25 and BPEP group 62.66 +/- 27.37 g). The HoLEP group showed a significantly better enucleation time (27.87 +/- 13.18 minutes vs 38.37 +/- 14.55 minutes), operative time (30.91 +/- 14.82 minutes vs 41.63 +/- 16.19 minutes), and enucleation efficiency (1.69 +/- 0.28 vs 1.28 +/- 0.06 g/min), with a lesser drop in hemoglobin (0.46 +/- 0.23 vs 0.87 +/- 0.26 g/dL). Bladder irrigation time, catheterization time, hospital stay, and sodium drop were comparable in both groups. One patient in the BPEP group needed clot evacuation. Both groups showed a significant reduction in IPSS, improvement in Qmax, reduction in PVR, and improved QoL scores at 3 months, which was maintained till 36 months. At the 3-year follow-up, two patients in each group needed reintervention for bladder neck contracture.Conclusions: HoLEP and BPEP provide comparable safety and efficacy in the treatment of bladder outlet obstruction due to BPH at the immediate and midterm (3-5 years) follow-up. HoLEP has an advantage of being faster with lesser perioperative morbidity.