Our Summary

This research paper compares two surgical procedures used to treat a condition called benign prostatic hyperplasia (BPH), which is an enlargement of the prostate gland. One technique uses a holmium laser to remove the prostate (HoLEP) while the other uses a robotic-assisted procedure (RASP).

The study found that both procedures are effective in treating BPH, showing similar results in terms of improving urinary flow and reducing residual urine volume. However, the laser technique (HoLEP) performed better in several areas: it shortened the operation time by about 50 minutes, reduced the hospital stay by 1.5 days, and decreased the time a catheter is needed by nearly 4 days. Additionally, patients who had the laser procedure had a 75% lower risk of needing a blood transfusion.

Moreover, patients who underwent the robotic-assisted procedure (RASP) had nearly twice the risk of developing moderate complications and more than three times the risk of developing serious complications. However, the robotic procedure can be more easily implemented in hospitals that are already equipped with robotic technology.

The study concludes that the best surgical outcomes can be achieved by reducing differences in the adoption of these techniques, improving surgical training, and following evidence-based guidelines.

FAQs

  1. What are the two surgical procedures compared in the study for treating benign prostatic hyperplasia (BPH)?
  2. How do the outcomes of the holmium laser (HoLEP) procedure and the robotic-assisted procedure (RASP) compare in terms of operation time, hospital stay, and the need for a catheter?
  3. What risks and benefits are associated with the robotic-assisted procedure (RASP) for treating BPH according to the study?

Doctor’s Tip

A doctor might tell a patient undergoing a prostatectomy to discuss with them the different surgical techniques available, such as holmium laser removal or robotic-assisted procedures, and the potential benefits and risks associated with each. They may advise the patient to choose the technique that is best suited to their individual needs and preferences, while also considering factors such as operation time, hospital stay, catheter duration, risk of complications, and availability of technology in their healthcare facility. It is important for the patient to be well-informed and to have open communication with their healthcare provider to ensure the best possible outcome for their prostatectomy.

Suitable For

Patients who are typically recommended prostatectomy for benign prostatic hyperplasia (BPH) are those who have not responded to other treatments such as medications or minimally invasive procedures. Symptoms of BPH include frequent urination, difficulty starting or maintaining a urine stream, weak urine flow, and the feeling of incomplete emptying of the bladder. Patients with severe symptoms that significantly impact their quality of life or lead to complications such as urinary retention or recurrent urinary tract infections may be candidates for prostatectomy.

Additionally, patients who have complications related to BPH such as bladder stones, urinary incontinence, or kidney damage may also be recommended for prostatectomy. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the best course of action for their individual situation.

Timeline

  • Before prostatectomy:
  1. Patient is diagnosed with BPH and discusses treatment options with their healthcare provider.
  2. Patient undergoes pre-operative evaluations, which may include blood tests, a physical examination, and imaging tests.
  3. Patient receives education on the procedure, potential risks, and post-operative care.
  4. Patient may need to make lifestyle changes or take medications to prepare for surgery.
  • After prostatectomy:
  1. Patient undergoes the surgical procedure, either HoLEP or RASP, under general anesthesia.
  2. Patient is monitored in the recovery room and may stay in the hospital for a few days.
  3. Patient may experience pain, discomfort, and urinary symptoms post-operatively.
  4. Patient may need a catheter for a period of time to help with urine drainage.
  5. Patient is discharged from the hospital and continues to recover at home.
  6. Patient follows up with their healthcare provider for post-operative care and monitoring.
  7. Patient gradually resumes normal activities and may undergo physical therapy or other treatments to aid in recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostatectomy include:

  1. What are the potential risks and complications associated with the prostatectomy procedure?
  2. How long is the recovery period after the surgery, and what can I expect in terms of pain and discomfort?
  3. Will I need to use a catheter after the surgery, and if so, for how long?
  4. What are the potential long-term effects of the surgery on my urinary function and sexual health?
  5. How experienced are you in performing prostatectomy procedures, and what is your success rate?
  6. Are there any alternative treatment options to consider before deciding on a prostatectomy?
  7. How will the choice between a laser technique (such as HoLEP) and a robotic-assisted procedure (such as RASP) impact my recovery and overall outcome?
  8. How soon after the surgery will I be able to return to normal activities, such as work and exercise?
  9. What follow-up care and monitoring will be necessary after the surgery?
  10. Are there any specific lifestyle changes or precautions I should take after the surgery to ensure optimal recovery and long-term health?

Reference

Authors: Benzouak T, Addar A, Prudencio-Brunello MA, Saed Aldien A, Amougou SE, AlShammari A, Ramadhan M, Carrier S, Aubé-Peterkin M, Hamouche F. Journal: J Urol. 2025 Feb;213(2):150-161. doi: 10.1097/JU.0000000000004297. Epub 2024 Oct 18. PMID: 39423101