Stellenwert der Holmium-Laserenukleation der Prostata (HoLEP) im Vergleich zur roboterassistierten transvesikalen Enukleation der Prostata (RASP): eine Propensity-Score-Matched-Analyse

摘要

This study investigates and compares the clinical safety and efficiency of Holmium Laser Enucleation of the Prostate (HoLEP) and robot-assisted transvesical enucleation of the prostate (RASP) for the treatment of benign prostatic hyperplasia (BPH) with large prostate volumes in a tertiary care centre. Perioperative data were collected from 39 patients who underwent RASP at our centre between 2015 and 2021. Propensity score matching was performed based on prostate volume, patient age, and body mass index (BMI), comparing these patients with 721 individuals treated with HoLEP at our clinic. An analysis was performed of preoperative parameters, including prostate volume, age, BMI, PSA level, IPSS score, and IIEF score, as well as intra- and postoperative parameters, including operative time, resected tissue weight, postoperative catheterization duration, length of hospital stay, haemoglobin decrease, transfusion rate, postoperative urinary retention, Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI). A statistically significant advantage was observed in favour of HoLEP regarding operative time (114.5 vs. 153.5 minutes; p<0.001), catheterization duration (2.6 vs. 7.4 days; p<0.001), and length of hospital stay (2.9 vs. 8.8 days; p<0.001). No statistically significant difference was found in terms of haemoglobin decrease or transfusion rate. The overall complication rate was lower in the HoLEP group, but the difference did not reach statistical significance (p=0.051). However, regarding the severity of complications, a statistically significant disadvantage for RASP was observed based on the CDC (p=0.027), while the CCI did not show a statistically significant difference between the cohorts (p=0.098). Both HoLEP and RASP proved to be effective and safe for the treatment of BPH with large prostate volumes. Compared to RASP, HoLEP demonstrated advantages in terms of catheterization duration and length of hospital stay. No statistically significant differences were observed regarding the overall complication rate.