Stellenwert der Holmium-Laserenukleation der Prostata (HoLEP) im Vergleich zur roboterassistierten transvesikalen Enukleation der Prostata (RASP): eine Propensity-Score-Matched-Analyse

Zusammenfassung

Einleitung

Untersuchung und Vergleich der klinischen Sicherheit und Effizienz der Holmium-Laserenukleation der Prostata (HoLEP) und der roboterassistierten, transvesikalen Enukleation der Prostata (RASP) zur Behandlung der benignen Prostatahyperplasie (BPH) mit großen Prostatavolumina in einem tertiären Versorgungszentrum.

Methoden

Erhoben wurden die perioperativen Daten von 39 Patienten, die zwischen 2015 und 2021 eine RASP in unserem Zentrum erhielten. Anhand des Prostatavolumens, des Patientenalters und des Body-Mass-Indexes (BMI) erfolgte ein Propensity Score Matching mit 721 mittels HoLEP an unserer Klinik behandelten Patienten. Präoperative Parameter wie Prostatavolumen, Alter, BMI, PSA-Wert, IPSS-Score, IIEF-Score sowie intra- und postoperative Parameter wie Operationszeit, Resektionsgewicht, postoperative Katheterliegedauer, Krankenhausverweildauer, Hämoglobinabfall, Transfusionsrate, postoperative Harnverhaltung, Clavien-Dindo-Klassifikation (CDC) und der Comprehensive Complication Index (CCI) wurden ausgewertet.

Ergebnisse

Es zeigte sich ein statistisch signifikanter Unterschied zugunsten der HoLEP hinsichtlich der Operationszeit (114,5 vs. 153,5 Minuten; p<0,001), der Katheterliegedauer (2,6 vs. 7,4 Tage; p<0,001) und der Krankenhausverweildauer (2,9 vs. 8,8 Tage; p<0,001). Hinsichtlich des Hämoglobinabfalls und der Transfusionsrate konnte kein statistisch signifikanter Unterschied nachgewiesen werden. Die Rate der Komplikationen war niedriger nach der HoLEP, jedoch nicht statistisch signifikant (p=0,051). In Bezug auf den Schweregrad der Komplikationen zeigte sich ein statistisch signifikanter Unterschied der CDC zuungunsten der RASP (p=0,027), der CCI wies jedoch keinen statistisch signifikanten Unterschied zwischen beiden Kohorten auf (p=0,098).

Schlussfolgerung

Sowohl HoLEP als auch RASP waren effektiv und sicher bei der Behandlung der BPH mit großem Prostatavolumina. Die HoLEP zeigte im Vergleich zu RASP Vorteile bei der Katheterisierungsdauer sowie der Krankenhausaufenthaltsdauer. Bezüglich der Rate an Komplikationen zeigten sich keine statistisch signifikanten Unterschiede.

Abstract

Introduction

This study investigates and compares the clinical safety and efficiency of Holmium Laser Enucleation of the Prostate (HoLEP) and robot-assisted transvesical enucleation of the prostate (RASP) for the treatment of benign prostatic hyperplasia (BPH) with large prostate volumes in a tertiary care centre.

Methods

Perioperative data were collected from 39 patients who underwent RASP at our centre between 2015 and 2021. Propensity score matching was performed based on prostate volume, patient age, and body mass index (BMI), comparing these patients with 721 individuals treated with HoLEP at our clinic. An analysis was performed of preoperative parameters, including prostate volume, age, BMI, PSA level, IPSS score, and IIEF score, as well as intra- and postoperative parameters, including operative time, resected tissue weight, postoperative catheterization duration, length of hospital stay, haemoglobin decrease, transfusion rate, postoperative urinary retention, Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI).

Results

A statistically significant advantage was observed in favour of HoLEP regarding operative time (114.5 vs. 153.5 minutes; p<0.001), catheterization duration (2.6 vs. 7.4 days; p<0.001), and length of hospital stay (2.9 vs. 8.8 days; p<0.001). No statistically significant difference was found in terms of haemoglobin decrease or transfusion rate. The overall complication rate was lower in the HoLEP group, but the difference did not reach statistical significance (p=0.051). However, regarding the severity of complications, a statistically significant disadvantage for RASP was observed based on the CDC (p=0.027), while the CCI did not show a statistically significant difference between the cohorts (p=0.098).

Conclusion

Both HoLEP and RASP proved to be effective and safe for the treatment of BPH with large prostate volumes. Compared to RASP, HoLEP demonstrated advantages in terms of catheterization duration and length of hospital stay. No statistically significant differences were observed regarding the overall complication rate.

Schlüsselwörter

Roboter-assistierte Enukleation der Prostata - Holmium - HoLEP - endoskopische Enukleation der Prostata - Prostatahyperplasie

Keywords

Holmium - HoLEP - Robot-Assisted Simple Prostatectomy - benign prostatic hyperplasia

^‡‡ Geteilte Letztautorenschaft

Publikationsverlauf

Eingereicht: 18. Februar 2025

Angenommen nach Revision: 02. April 2025

Artikel online veröffentlicht:
21. Mai 2025

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