Holmium Laser Enucleation of the Prostate Versus Robot-Assisted Simple Prostatectomy for Benign Prostatic Obstruction: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.
Giulia Luiza Garcia, Bernardo Fontel Pompeu, Gabriel Leal Barone et al.
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In 30 seconds
This systematic review and meta-analysis compared holmium laser enucleation of the prostate (HoLEP) with robot-assisted simple prostatectomy (RASP) for benign prostatic obstruction. Across 13 studies involving 1993 patients, HoLEP was associated with shorter operative time, fewer transfusions and fewer Clavien-Dindo grade III–IV complications, as well as earlier catheter removal. Most measured functional outcomes were similar, although postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96). The authors conclude that HoLEP offers perioperative safety advantages, while noting that further high-quality comparative studies are needed to establish long-term effectiveness.
Key findings
- HoLEP was associated with 32.05 minutes shorter operative time (MD = -32.05 minutes).
- Transfusion rates were lower with HoLEP (OR = 0.34), as were Clavien-Dindo grade III and IV complications (OR = 0.39).
- Catheter removal occurred earlier after HoLEP (MD = -3.84 days).
- Postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96); no significant differences were reported for most other functional outcomes.
Why it matters
The comparison informs procedural discussions for benign prostatic obstruction by suggesting that HoLEP may reduce several perioperative burdens without clear differences in most reported functional outcomes. The modest symptom-score advantage for RASP and the need for stronger long-term comparative evidence mean that the findings do not establish one procedure as preferable for every patient.
What to keep in mind
The review included 13 comparative studies, and the authors state that further high-quality studies are needed to confirm long-term effectiveness.