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HoLEP provides a higher prostate cancer detection rate compared to bipolar TURP: a matched-pair analysis

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Abstract

Purpose

Holmium laser enucleation of the prostate (HoLEP) has become a popular alternative to TURP for desobstructive prostate surgery. The prevalence of incidental prostate cancer (iPCa) during surgery varies depending on many preoperative factors. To evaluate whether the surgical procedure itself (HoLEP vs. TURP) influences iPCa detection, we performed a case-by-case matched-pair analysis.

Methods

Preoperative patient age, total PSA, and prostate volume were used as matching criteria. Descriptive statistics were used to confirm matching quality. Parameters were analyzed by Fisher’s exact test and T test or Mann–Whitney U test for dichotomous and continuous variables, respectively. Uni- and multivariate logistic regression analyses were performed to identify predictors for iPCa detection.

Results

60 out of 136 patients after HoLEP and 60 out of 1220 patients after bipolar TURP (bTURP) could be included. Mean patient age was 71.5 and 70.3 years in the HoLEP and bTURP group, respectively. Median preoperative total PSA was 4.42 ng/ml for HoLEP and 4.33 ng/ml for bTURP patients. Median preoperative prostate volume was 75.0 cc in both groups. Mean percentage of tissue removed by HoLEP and bTURP was 63.5 and 49.5% (p < 0.001), respectively. IPCa was found in 23.3% of HoLEP specimens compared to 8.3% in bTURP (p = 0.043). PSA density was the only independent predictor for iPCa detection.

Conclusions

In this first matched-pair analysis, HoLEP provides a significantly higher iPCa detection rate than bTURP. This might be a result of a more efficient tissue removal during HoLEP. PSA density was the only independent risk factor for iPCa.

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Authors and Affiliations

  1. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany

    Bernd Rosenhammer, Eva M. Lausenmeyer, Roman Mayr, Maximilian Burger & Christian Eichelberg

Authors
  1. Bernd Rosenhammer
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  2. Eva M. Lausenmeyer
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  3. Roman Mayr
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  4. Maximilian Burger
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  5. Christian Eichelberg
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Contributions

B. Rosenhammer: project development, data collection and analysis, and manuscript writing. E.M. Lausenmeyer: project development, data collection, and manuscript editing. R. Mayr: manuscript editing. M. Burger: manuscript editing. C. Eichelberg: project development, and manuscript writing and editing.

Corresponding author

Correspondence to Bernd Rosenhammer.

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The authors declare to have no conflicts of interest. There was no funding for this study.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol (#17-777-101) was approved by the ethics committee of the University of Regensburg.

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Rosenhammer, B., Lausenmeyer, E.M., Mayr, R. et al. HoLEP provides a higher prostate cancer detection rate compared to bipolar TURP: a matched-pair analysis. World J Urol 36, 2035–2041 (2018). https://doi.org/10.1007/s00345-018-2353-0

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  • DOI: https://doi.org/10.1007/s00345-018-2353-0

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