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HoLEP versus PVP in prospective randomised trial

Presented by
Dr Yan-Bo Chen, Shanghai Jiao Tong University, China
EAU 2020
Both holmium laser enucleation of the prostate (HoLEP) and photoselective laser vaporisation of the prostate (PVP) are comparably safe and effective as treatments for benign prostatic hyperplasia (BPH). However, data from a prospective randomised trial suggests that the long-term outcomes of HoLEP surgery may be better.

Dr Yan-Bo Chen (Shanghai Jiao Tong University, China) presented a study that directly compared 2 different laser systems which each produce different qualitative and quantitative effects in tissue [1]. The primary outcome was perioperative safety and 24-month follow-up efficacy data.

A total of 314 BPH patients (estimated prostate volume <60 mL, urodynamics-confirmed BPH) were randomly assigned 1:1 to receive either HoLEP or PVP. Operating times were longer for the patients receiving HoLEP (median 52.3±12.2 minutes) compared with PVP (46.6±12.0 minutes; P<0.001). There was no significant difference in the success rate of removal of the catheter between the 2 groups within 24 hours after operation (HoLEP 94.9% vs PVP 96.2%; P>0.05). Both groups displayed significant improvements in prostate volume after the surgery, although the reduction observed with HoLEP was significantly better when measured at 6 months and 24 months post-intervention (see Table). There were no differences between the 2 arms in outcomes of the international prostate symptom score (IPSS), quality of life (QoL), or peak urinary flow rate (Qmax) values (all P>0.05). The reoperation rate in the HoLEP group was significantly lower with 24-month follow-up (0% vs 3.8%; P=0.013), although the rate of transient incontinence was higher in the HoLEP group (8.3% vs 2.5%; P=0.025). Collectively, these results slightly favour HoLEP over PVP, although validation of this study is still warranted.

Table: Baseline and follow-up data [1]

IPSS, international prostate symptom score; HoLEP, holmium laser enucleation of the prostate; PVP, photoselective laser vaporisation of the prostate; QoL, quality of life; Qmax, peak urinary flow rate; PV, prostate volume.

    1. Chen YB, et al. EAU20 Virtual Congress, 17-26 July 2020, Abstract 831.



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