Endoscopic en bloc prostate enucleation: a propensity score matched analysis between greenlight enucleation of prostate (GreenLEP) vs holmium laser enucleation of prostate (HOLEP) outcomes and safety with a 12-month follow-up.

Abstract

Purpose: Greenlight has been successfully used to treat BPH since 2010s; however, its role during GreenLEP is still under investigation, differently from holmium in HOLEP. Study aim is to compare GreenLEP and HOLEP.

Methods: Data for GreenLEP and HOLEP were prospectively collected in two referral centers since 2021. Outcomes and safety were compared through propensity score matching. All patients had at least 12-month follow-up.

Results: A total of 120 patient who underwent GreenLEP and 115 HOLEP were enrolled. At unmatched comparison, median PSA and age were comparable, as well as prostate volume, with a median of 98.5 (IQR 82.0-130.0)ml and 90.0 (IQR 65.0-115.0)ml, respectively; on the contrary, IPSS (p = 0.013) and indwelling catheter rate (p =  < 0.001) were higher in HOLEP group. Moreover, safety and functional outcomes were comparable, besides lower PSA and IPSS were found at 12-month follow-up in HOLEP group (p < 0.001). Using propensity score matching on 56 GreenLEP and 56 HOLEP, the groups were comparable for age, prostate volume, PSA, ongoing anticoagulant and anti-aggregant therapy, ongoing BPH therapy, pre-operative hemoglobin values, indwelling catheter presence, and IPSS. Regarding outcomes, they were all comparable except lower IPSS and PSA at 6- and 12-month follow-up for HOLEP. Conversely, late complications and stress incontinence were higher in HOLEP (1.8% vs 16.1%, p = 0.008), but at multivariate analysis, there was no significant difference.

Conclusion: According to our results, both HOLEP and GreenLEP are effective in treating BPH in large prostates. However, HOLEP provided slightly better IPSS and PSA reduction, while GreenLEP demonstrated fewer late complications. Further randomized clinical trials are mandatory.