Top-Down Holmium Laser Enucleation of the Prostate (HoLEP) vs the Traditional HoLEP for Treatment of Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia, Lower Urinary Tract Symptoms
About this trial
This is an interventional diagnostic trial for Benign Prostatic Hyperplasia
Eligibility Criteria
Inclusion Criteria:
- Males over 50 years of age at the time of enrollment
- Referred to urology for refractory LUTS secondary to BPH
- Failed medical (non-surgical) treatment
- Prostate size on preoperative TRUS of > 80 ml
- IPSS >15, QOL score ≥3 and Qmax <15 ml/sec
- Written informed consent to participate in the study
- Ability to comply with the requirements of the study procedures
Exclusion Criteria:
- Previous surgical treatment for BPH
- Presence of bladder stones
- History of prostate cancer
- Prostate size < 80 mL
- History of urethral stenosis or its management
- Known or suspected neurogenic bladder
- Participants with active urinary tract infection until appropriately treated
- Participants with preexisting conditions, which, in the opinion of the investigator, interfere with the conduct of the study
- Participants who lack the capacity, or cannot speak English, in order to provide free and informed written consent
Sites / Locations
- Thunder Bay Regional Health Sciences Centre/Thunder Bay Regional Health Research Institute
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Traditional HoLEP
Top-Down HoLEP
Holmium laser enucleation of the prostate (HoLEP), first reported by Fraundorfer et al in 1998, is a more recent step in the evolution of holmium laser prostatectomy. HoLEP is a safe and effective procedure which has demonstrated comparable results to Transurethral Resection of the Prostate (TURP) and open prostatectomy for patients with symptomatic enlarged prostate, with low morbidity and short hospital stay [4]. The improvement in outcome parameters is durable, and the late complications and reoperation rates reported are very low [5]. HoLEP is equally suitable for small, medium and larger prostate glands, with clinical outcomes that are independent of prostate size, unlike TURP. HOLEP offers patients the alterative of being treated endoscopically with minimal blood loss, short catheterization time, and decreased hospital stay [6].
The "Top-Down" HoLEP technique is a novel technique which offers potential benefits to the Traditional HoLEP procedure, including decreased complexity, a reduced learning curve, with anticipated improved continence [8]. A variation of this method is also being explored in Japan (termed the "en-bloc technique with anteroposterior dissection HoLEP") [9]. The main difference between the Top-Down and Traditional approach is that the direction of lateral dissection begins from upwards to downwards. This could help in avoiding the overtraction of the mucosal strip overlying the posterior urethral sphincter, which theoretically leads to a decrease in the incidence of postoperative stress incontinence. Moreover, using the Top-Down approach should lead to a decrease in the incidence of lost enucleation planes, which results in decreasing the intraoperative time and decreasing the number of cases required to master the HoLEP technique.