Holmium Laser Enucleation of the Prostate vs Multi-Port Robotic-Assisted Simple Prostatectomy vs Single-Port Robotic-Assisted Simple Prostatectomy: A Single-Center Experience

Abstract

Introduction:

Holmium laser enucleation of the prostate (HoLEP), multi-port robotic simple prostatectomy (MP-RASP), and single-port robotic simple prostatectomy (SP-RASP) are three widely accepted treatment options for benign prostatic hyperplasia. We present the first study to directly compare all three modalities.

Methods:

Patients undergoing HoLEP, MP-RASP, or SP-RASP between 2022 and 2024 were retrospectively analyzed. Various preoperative, perioperative, and postoperative variables and outcomes were assessed.

Results:

A total of 92 HoLEP, 42 MP-RASP, and 59 SP-RASP patients were analyzed. The mean prostate size was larger for MP-RASP compared to HoLEP and SP-RASP (p < 0.001). Mean operative times were lower for HoLEP compared to MP-RASP and SP-RASP (p < 0.001). Estimated blood loss (EBL) was significantly different between all three cohorts (p < 0.001). Transfusion rates were no different (p = 0.2). The mean prostate tissue removed during the surgical procedure was significantly higher for MP-RASP vs HoLEP (p < 0.001) and MP-RASP vs SP-RASP (p < 0.001) but not for SP-RASP vs HoLEP (p = 0.22). Mean catheter duration was significantly higher for MP-RASP compared to HoLEP and SP-RASP (p < 0.001). 31% of MP-RASP and 63% of SP-RASP patients were discharged the same day compared to 8% of HoLEP. The transient incontinence rates were 30% for HoLEP vs 17% for MP-RASP vs 8% for SP-RASP (p = 0.004).

Conclusion:

HoLEP had a decreased operative time, shorter catheter duration, and increased incontinence rates, whereas both MP-RASP and SP-RASP had a greater amount and percentage of prostatic tissue removed. MP-RASP removed a greater amount of tissue and had a longer catheter duration compared to SP-RASP.