Dados do Trabalho

Título

HOLMIUM LASER ENUCLEATION OF THE PROSTATE VERSUS LAPAROSCOPIC SIMPLE PROSTATECTOMY: EXPERIENCE FROM A RESIDENCY PROGRAM

Resumo

Surgical treatment of Benign Prostatic Hyperplasia (BPH) is indicated for patients with severe symptoms, complications, or those who have not responded to medical therapy. Various surgical approaches exist for treating BPH, including resection, enucleation, vaporization, and other ablative and non-ablative techniques. Teaching modern techniques such as Holmium laser enucleation of the prostate (HoLEP) and laparoscopic simple prostatectomy (LSP) is crucial to the training of new urologists. These methods offer less invasive options with benefits like quicker recovery and fewer postoperative complications. The objective of this study is to retrospectively compare data from patients who underwent HoLEP and LSP performed by second-year urology residents at a tertiary care facility. This retrospective study analyzes and compares two surgical treatment methods for BPH during the period of January 2015 to November 2023. Data was collected from patients' electronic medical records. Collected variables included patient demographic characteristics, preoperative clinical data, duration of the surgical procedure, length of hospital stay, intraoperative and postoperative complications. A total of 174 patients were included (77 in the LSP group and 97 in the HoLEP group). Preoperative characteristics such as age, comorbidities, use of an indwelling urinary catheter, and use of finasteride were similar between the two groups. The mean prostate volume was higher in the LSP group compared to the HoLEP group (133g vs. 87g, p = 0.055). The surgical time was shorter for patients undergoing HoLEP (142 minutes vs. 251 minutes, p < 0.001). There was a statistically significant difference in favor of HoLEP for the average length of stay (3.9 vs. 1.27 days; p < 0.001) and hemoglobin drop (2.66 g/dL vs. 1.94 g/dL; p < 0.001). There was no difference in the percentage of resected tissue (LP 56.7% vs. HoLEP 60.34%; p = 0.079) and maximum urinary flow after surgery (LSP 27ml/s vs HoLEP 28ml/s; p = 0.4). The complication rate was higher in the LSP group but the difference was not statistically significant (16% vs. 7%; p = 0.081). In a medical residency teaching setting both methods were effective for treating BPH with resection of more than 50% of the prostate volume and improvement of maximum urinary flow. The results suggest that HoLEP may offer advantages over LSP regarding surgical efficiency, safety and patient recovery.

Palavras Chave

Prostate; Enucleation;