Abstract
Objectives
To assess the functional outcome and cumulative health-resource-related cost of holmium laser enucleation of the prostate (HoLEP) in comparison with transvesical open prostatectomy (TVOP) in a developing country.
Methods
Matching of 92 HoLEP and 91 TVOP procedures was performed using resected prostate tissue weight as a sole matching criterion. Safety, efficacy, and accordingly health-related cost-efficiency of both procedures were statistically compared.
Results
Preoperative criteria and mean prostate size (166.7 ± 49.7, 161.4 ± 35.7 ml) were similar in HoLEP and TVOP, respectively; however, HoLEP treated more comorbid patients. Blood transfusion was 2.1 and 26.1 % after HoLEP and TVOP, respectively (P = 0.001). Median time to catheter removal and hospital stay was 2 days after HoLEP and 5 and 9 days, respectively, after TVOP (P < 0.001). On modified Clavien scale, grade per grade, there was no statistically significant difference between the two groups apart from local wound complications in TVOP group. High-grade complications (≥ grade 3) were reported in 3.2 and 6.5 % in HoLEP and TVOP, respectively (P = 0.49). Resected prostate tissue weight was independently associated with high-grade periprocedure complications (OR[95 %CI] 1.22[1.02:1.49], P = 0.03). Last follow-up symptom score, peak urine flow rate, residual urine, % PSA reduction, and need for reoperation were comparable between the two groups. HoLEP costs the hospital in the first 3 months 4111.8EP (575US$) versus 4305.4EP (602US$) for TVOP (P = 0.09).
Conclusion
In high-volume hospital, HoLEP procedure seems to be equally safe and effective as TVOP with the advantages of minimally invasive procedures. Two years after adopting the technique, HoLEP equally costs the hospital as TVOP. Significant hospital cost savings are anticipated in subsequent cases.
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References
Oelke M, Descazeaud A, Emberton M, Gravas S, Michel MC, N’Dow J, Nordling J, de la Rosette JJ (2013) Guidelines on the management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Eur Assoc Urol 12:42–44
Elshal Ahmed M, El-Nahas Ahmed R, Barakat Tamer S et al (2013) Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: perioperative outcomes of a contemporary series. Arab J Urol 11:362
Gupta NP, Anand A (2009) Lasers are superfluous for the surgical management of benign prostatic hyperplasia in the developing world. Indian J Urol 25:413
Fraundorfer MR, Gilling PJ (1998) Holmium: YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33:69
Kuntz RM, Lehrich K, Ahyai SA (2008) 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. Eur Urol 53:160
McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803
Cornu JN, Ahyai S, Bachmann A et al (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096
Baazeem AS, Elmansy HM, Elhilali MM (2010) Holmium laser enucleation of the prostate: modified technical aspects. BJU Int 105:584
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205
Elshal AM, Elkoushy MA, El-Nahas AR et al (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934
Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246
Tubaro A, de Nunzio C (2006) The current role of open surgery in BPH. EAU-EBU Update Series 4:191
Kuntz RM, Lehrich K (2002) Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm: a randomized prospective trial of 120 patients. J Urol 168:1465
Krambeck AE, Handa SE, Lingeman JE (2010) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 183:1105
Elshal AM, Elmansy HM, Elhilali MM (2012) Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostate hyperplasia (BPH). BJU Int 110:E845
Gilling PJ, Wilson LC, King CJ et al (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109:408
Naspro R, Suardi N, Salonia A et al (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50:563
Salonia A, Suardi N, Naspro R et al (2006) Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology 68:302
Yin L, Teng J, Huang CJ et al (2013) Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 27:604
Acknowledgments
Ahmed M. Elshal and Ahmed El-Nahas are responsible for Protocol/project development; Ramy Mekkawy, Tamer S. Barakat, and Mohamed M. Elsaadany performed data collection or management; Ahmed El-Assmy carried out data analysis; Mahmoud Laymon, Ahmed R. El-Nahas, and Ahmed M. Elshal are responsible for manuscript writing/editing.
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Elshal, A.M., Mekkawy, R., Laymon, M. et al. Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country?. World J Urol 34, 399–405 (2016). https://doi.org/10.1007/s00345-015-1639-8
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DOI: https://doi.org/10.1007/s00345-015-1639-8