A comparison of TURP, HoLEP, and RFA for nonneurogenic LUTS in men

TL;DR

This study compares three prostate treatments for urinary symptoms and finds that TURP and HoLEP are equally effective, while RFA is less effective but has fewer incontinence issues.

Contribution

The study provides a direct comparison of TURP, HoLEP, and RFA for nonneurogenic LUTS in men over a 36-month period.

Findings

TURP and HoLEP showed similar improvement in IPSS, but HoLEP had higher incontinence rates.

RFA had lower IPSS improvement but the lowest incontinence rates, making it suitable for older patients.

None of the techniques improved OAB-V8 scores over time.

Abstract

The effect of transurethral resection of the prostate (TURP) for nonneurogenic male lower urinary tract symptoms (LUTS) is well known. However, recent advancements have come into use, so studies have been done to compare these new techniques to the gold standard TURP technique. The aim of this study was to compare the results of TURP, holmium laser enucleation of the prostate (HoLEP), and radiofrequency ablation (RFA) in men.

The patients who had the TURP procedure were defined as group 1 (G1), those who had HoLEP were in group 2 (G2), and those who had RFA were in group 3 (G3). Preoperative and postoperative results were compared, with postoperative checks done at 1, 12, 24, and 36 months.

There were 41, 40, and 40 patients in G1, G2, and G3, respectively. The mean ages for G1, G2, and G3 were 68.21 ± 8.19, 65.44 ± 10.48, and 77.32 ± 10.58, respectively. The decrease in international prostate symptom score (IPSS) was similar in G1 and G2 for all follow-up periods, but the decrease for G3 was smaller. The quality of life improvement can be summarized as G1 > G2 > G3 at the 36-month follow-up. Scores on the overactive bladder questionnaire (OAB-V8) decreased at the 1-month follow-up for G1 and G2, but then started to increase again over time. Scores on the international index of erectile function (IIEF-5) improved in a continuous fashion up to the 36th postoperative month for G1. The incontinence rate was highest in G2 for all time periods despite a decrease after the first postoperative month. The incontinence rate was the lowest for G3 across all time periods.

The TURP and HoLEP procedures yielded equal improvement in IPSS, however HoLEP had a higher incontinence rate. RFA did not yield much improvement in IPSS, however it seems suitable for older patients with the lowest incontinence rates. None of the techniques provided an improvement in terms of the OAB-V8.

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