Holmium Laser Enucleation of the Prostate versus Open Prostatectomy for Prostates Greater than 100 Grams: 5-Year Follow-Up Results of a Randomised Clinical Trial

ObjectivesTo report 5-year follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with open prostatectomy (OP).MethodsOne hundred twenty patients with prostates greater than 100 g in weight according to transrectal ultrasound were randomised to either the HoLEP or the OP group (ie, 60 patients to each group). Preoperative and postoperative assessments included American Urological Association Symptom Score (AUA-SS), maximum urinary flow rates (Qmax), and postvoid residual urine (PVRU) volumes. Measurements were performed at 1, 3, 6, 12, 18, 24, 36, 48, and 60 mo. Postoperative outcome data were compared. All complications were recorded.ResultsFive years postoperatively, a total of 46 patients (38.3%) were lost to follow-up or had to be excluded from the study. All the remaining 74 patients (42 HoLEP vs. 32 OP patients, p = 0.11) had undergone the 5-yr follow-up assessments. Mean AUA-SS was 3.0 in both groups (p = 0.98), mean Qmax was 24.4 ml/s in both groups (p = 0.97) and PVRU volume was 11 ml in the HoLEP and 5 ml in the OP group (p = 0.25). Late complications consisted of urethral strictures and bladder-neck contractures; reoperation rates were 5% in the HoLEP and 6.7% in the OP group (p = 1.0). No patient developed benign prostatic hyperplasia recurrence.ConclusionsFive years after the operation, the improvements in micturition obtained with HoLEP and OP were equally good, and reoperation rates similarly low. HoLEP seems to be a true endourological alternative to OP.