Functional outcomes and safety profile of thulium: YAG laser enucleation (ThuLEP) versus robot-assisted simple prostatectomy (RASP) facing very large (≥ 150 ml) prostates

Purpose: To compare outcomes between endoscopic enucleation of the prostate with Thulium: YAG laser (ThuLEP) and robot-assisted simple prostatectomy (RASP) in the treatment of prostates ≥ 150 ml. Materials and methods: Patients with benign prostatic obstruction and prostate volume ≥ 150 ml underwent ThuLEP (Group A) versus transvesical RASP (Group B). Operative time, length of stay, catheterization time, haemoglobin drop were recorded. Functional outcomes were evaluated through the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual (PVR). Complications rate was compared. Results: 200 patients were treated, 100 for each group with comparable preoperative features. Mean prostate volume was 178.6 ml in Group A vs. 186.3 ml in Group B (p = 0.11). Mean total operative time was 82.7 vs. 66.3 min (p = 0.04), catheterization time 3.5 vs. 7.3 days (p = 0.05), length of stay 2.5 vs. 4.8 days (p = 0.04), haemoglobin drop 0.7 vs. 1.3 g/dl (p = 0.06) after ThuLEP vs. RASP. No differences were observed in mean IPSS, Qmax and PVR. Higher rates of urinary infections (4.0% vs. 8.0%, p = 0.05) and urinary retention (4.0% vs. 9.0%, p = 0.04) occurred after RASP. Higher rates of temporary urgency (12.0% vs. 4.0%, p = 0.03) and urge incontinence (3.0% vs. 0%, p = 0.04) were observed after ThuLEP, with no differences in stress incontinence. Conclusions: ThuLEP and RASP in expert hands are equally effective to treat very large prostates (≥ 150 ml) with no significant differences in micturition improvements. Operative time is shorter with RASP. Complication profile is different between the two procedures with no differences in major adverse events.