Comparison of Robotic vs Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia

Abstract

Introduction and Objective:

To compare robotic transabdominal enucleation of the prostate (RTEP) and laser enucleation of the prostate (LEP) concerning perioperative and functional outcomes for the treatment of benign prostatic hyperplasia (BPH).

Methods:

This retrospective cohort study included 476 patients who underwent RTEP (n = 68) or LEP (n = 408) from 2014 to 2021. Data collected included demographic information, preoperative characteristics, and perioperative details such as surgical time, blood loss, complications, and length of stay. Postoperative outcomes, including post-void residual (PVR), bladder neck contracture (BNC), and stress urinary incontinence (SUI), were also evaluated. Statistical analysis was performed using univariable and multivariable logistic regression.

Results:

Baseline characteristics were similar between groups, except for prostate size (RTEP: 125 g vs LEP: 94 g; p < 0.001). LEP patients had shorter surgery times (139 vs 190 minutes; p < 0.001), lower blood loss (75 vs 255 mL; p < 0.001), and shorter hospital stays (1 vs 2 days; p < 0.001). RTEP had greater postoperative complications (34.3% vs 19.7%; p = 0.007) but no difference in Grade ≥3a complications (5.9% vs 3.7%; p = 0.417). Notably, RTEP had lower rates of transient (4.4% vs 21.3%) and prolonged (4.4% vs 15.1%) SUI. No differences were noted between groups for PVR, BNC, or irritative voiding symptoms. Patients undergoing RTEP had a 75% lower risk of prolonged SUI after surgery than LEP on multivariable analysis. The final rate of unresolved, prolonged SUI was not different between groups (2.9% vs 5.7%).

Conclusion:

RTEP and LEP are safe and effective treatments for large-volume BPH. Although LEP offers advantages in shorter operative time and recovery, RTEP is associated with a significantly lower rate of prolonged urinary incontinence.