Minimally Invasive Techniques for Large-Volume Benign Prostatic Hyperplasia: A Comparative Study between HoLEP and Robotic Simple Prostatectomy

Purpose: To compare perioperative outcomes, functional results, quality of life, and complications between robot-assisted simple prostatectomy (RASP) and Holmium laser prostate enucleation (HoLEP) as minimally invasive techniques for treating benign prostatic hyperplasia (BPH) in large prostates (>150 cm³). Methods : This retrospective, multicentre, randomized, observational study (2007–2023) included patients with >150 cm³ prostate volumes who underwent either HoLEP or robot-assisted prostatectomy. Primary outcomes: success rate (complete enucleation, without transfusion or reintervention), good postoperative quality of life (IPSS 8 ^th question score: 0-2), and continence at 6 months (no pads). Secondary outcomes: operative and catheterization time, hospital stay, enucleated gland weight, PSA reduction, Qmax improvement, and perioperative complications. Results : We included 95 HoLEP and 50 RASP patients with similar demographics and prostate volume (HoLEP: 187.72 cm³; RASP: 203.38 cm³). The success rate (HOLEP: 83.2%; RASP: 74%), continence rate (HoLEP: 85.1%; RASP: 86%) and quality of life (HoLEP: 83.2%; RASP 94%) were similar (p=0.275; p=1; p=0.075; respectively). HoLEP had shorter operative time (97.58 vs 122.4 min) and catheterization duration, with similar hospitalization duration (HoLEP: 3.46 days; RASP: 4.22 days). Although there was no significant difference in enucleated gland weight, HoLEP was more efficient (1.28 g/min vs 1.06 g/min). Complication rates were similar (HOLEP: 15.5%; RASP: 26%; p=0.12). Conclusions : Both RASP and HoLEP are safe for treating BPH in prostates >150 cm³, reporting similar success and continence rates, and good quality of life after surgery. However, HoLEP achieved results with shorter operative time and catheterization duration.