Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer

Alexander Tamalunas; Patrick Keller; Melanie Schott; Leo Federico Stadelmeier; Marc Kidess; Michael Atzler; Benedikt Ebner; Martin Hennenberg; Christian G Stief; Giuseppe Magistro

doi:10.1038/s41391-024-00831-1

Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer

Prostate Cancer Prostatic Dis. 2024 Apr 10. doi: 10.1038/s41391-024-00831-1. Online ahead of print.

Affiliations

¹ Department of Urology, University Hospital, LMU Munich, Munich, Germany. alexander.tamalunas@med.uni-muenchen.de.
² Department of Urology, University Hospital, LMU Munich, Munich, Germany.
³ Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany.

PMID: 38600321
DOI: 10.1038/s41391-024-00831-1

Abstract

Background: While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP.

Methods: We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes.

Results: While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients.

Conclusions: Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.