From the Guidelines
New surgical treatments for urinary retention, such as holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate, have shown improved outcomes with fewer complications compared to traditional transurethral resection of the prostate (TURP) 1.
Overview of New Surgical Treatments
- HoLEP has been shown to be a safe and effective treatment for benign prostatic hyperplasia (BPH), with a low risk of complications and improved quality of life outcomes [@19@, @36@].
- Thulium laser enucleation of the prostate has also been shown to be a safe and effective treatment for BPH, with a low risk of complications and improved quality of life outcomes [@172@, @173@].
- Other new surgical treatments, such as aquablation and Rezum water vapor therapy, have also shown promise in treating urinary retention with minimal side effects and preserving sexual function [@191@, @193@].
Comparison of New Surgical Treatments
- A systematic review and meta-analysis of randomized controlled trials found that HoLEP and thulium laser enucleation of the prostate had similar efficacy and safety profiles, but HoLEP had a slightly lower risk of complications [@Hartung FO et al.@].
- Another study found that aquablation had a lower risk of sexual dysfunction compared to TURP, but a higher risk of urinary tract infections [@Kasivisvanathan V et al.@].
Recommendations
Based on the most recent and highest quality evidence, HoLEP is recommended as a first-line treatment for urinary retention due to BPH, due to its low risk of complications and improved quality of life outcomes 1.
- Thulium laser enucleation of the prostate and aquablation are also recommended as alternative treatments, depending on patient preferences and individual circumstances.
- Rezum water vapor therapy and other new surgical treatments may be considered for patients who are not candidates for HoLEP or thulium laser enucleation of the prostate.
From the Research
New Surgical Treatments for Urinary Retention
- Holmium laser enucleation of the prostate (HoLEP) is a surgical management option for treatment of symptomatic benign prostatic hyperplasia (BPH) and has been shown to be effective in treating patients with urinary retention 2.
- Thulium laser enucleation of the prostate (ThuLEP) is another surgical option that has been compared to HoLEP, with results showing equivalent efficacy and safety in relieving lower urinary tract symptoms 3.
- Prostatic urethral lift (PUL) is a minimally invasive procedure that has been shown to be efficacious in treating lower urinary tract symptoms (LUTS) in patients with BPH, including those with urinary retention 4.
- Water vapor thermal therapy (Rezum) is another minimally invasive procedure that has been shown to be effective in relieving LUTS in patients with BPH, with the added advantage of preserving sexual function 5.
Characteristics of New Surgical Treatments
- HoLEP has been shown to have durable long-term outcomes, with significant improvements in subjective and objective outcomes extending beyond 10 years 6.
- ThuLEP has been shown to have a shorter operative time and enucleation time compared to HoLEP, although the differences were clinically negligible 3.
- PUL has been shown to be a promising surgical technique that can alleviate LUTS, even in patients with severe obstruction, with significant improvements in Qmax, PVR, IPSS, and QOL 4.
- Rezum and UroLift have been shown to be office-based, minimally invasive techniques capable of providing durable and significant relief of LUTS secondary to BPH, with the added advantage of preserving sexual function and minimizing patient morbidity and healthcare cost 5.