(UroToday.com) The 2022 WCET annual meeting included a Monday plenary session during which Dr. Nicole Miller and Professor Abhay Rane debated methods for managing the treatment of BPH with small prostates. Professor Rane spoke first and outlined reasons for managing BPH in patients with small prostates, under 40 grams, via transurethral resection (TURP). Professor Rane concluded his talk by exclaiming that in most cases today, resection will not be needed for prostates below 40 grams. He pointed out that there is no right or wrong treatment option and that either resection via TURP or HoLEP is equally acceptable for such cases. Professor Rane stated that it is more important for urologists to offer their patients the treatment option that they are more familiar with and comfortable performing.
Following this, Dr. Miller made some assertions regarding her thoughts on the use of laser enucleation for BPH. She noted that since 2005, it has been shown in the literature that holmium laser enucleation of the prostate (HoLEP) is the standard of choice for BPH treatment independently of prostate size. Dr. Miller also outlined that other studies have confirmed this finding, as recently as 2021. She noted that multiple systematic reviews and review articles have demonstrated that, compared to TURP, HoLEP treatment leads to lower blood loss, lower catheterization times, less length of stay, and lower rate of blood transfusions. Dr. Miller spoke about how these outcomes are true independent of prostate size, and cited the systematic reviews in the slide below:
Dr. Miller proceeded to speak about how currently, in the AUA guidelines, holmium and thulium laser enucleation of the prostate are listed as the only treatment recommendations for all prostate sizes based on level 1 evidence. Risk of bladder contractures, she exclaimed, is less when using an endoscopic laser enucleation compared with TURP.
The debate concluded with some key take home messages from Dr. Miller. Her ending points were:
- Endoscopic enucleation, in particular HoLEP, has distinguished itself as the size independent standard of treatment for BPH.
- Laser energy has unique benefits in addressing the bladder neck obstruction which is common in smaller prostates.
Presented by:
- Nicole L. Miller, MD, FACS - Professor of Urology, Vanderbilt University Medical Center, Nasville, Tennessee, United States
- Abhay Rane, OBE, FRCS - Professor of Urology, Surrey and Sussex NHS Trust, Redhill, United Kingdom and Director of the Endourological Society.
Written by: Allen Rojhani, BS - MD Candidate at the Drexel University College of Medicine and 2022-2023 LIFT Research Fellow at the University of California, Irvine Department of Urology, @allenrojhani on twitter, during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.