Comparison of Transurethral Resection of the Prostate and Laser Enucleation for Benign Prostatic Hyperplasia

Abstract

Background: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms in older men and may require surgical intervention when symptoms are severe or refractory to medical therapy.

Objective: To compare perioperative outcomes, functional improvement, and postoperative complications between transurethral resection of the prostate (TURP) and laser enucleation in patients with BPH.

Methods: This prospective comparative study was conducted at Department of Urology, Sahiwal Teaching Hospital, Sahiwal from March 2024 to December 2024 and included 90 patients with symptomatic BPH. Patients were divided into two groups, with 45 undergoing TURP and 45 undergoing laser enucleation. Baseline characteristics, operative time, amount of tissue removed, reduction in hemoglobin level, transfusion requirement, duration of bladder irrigation, catheterization time, length of hospital stay and postoperative complications were recorded. Functional outcomes were assessed at 3 and 6 months after surgery.

Results: Baseline characteristics were comparable between the two groups. Laser enucleation was associated with a longer operative time than TURP (74.2 ± 18.4 vs. 61.5 ± 15.8 minutes; p<0.001) but resulted in a greater amount of tissue removal (42.1 ± 12.4 vs. 34.6 ± 10.2 g; p=0.002). The reduction in hemoglobin level was significantly lower in the laser enucleation group (0.74 ± 0.41 vs. 1.42 ± 0.66 g/dL; p<0.001). The duration of bladder irrigation, catheterization time, and hospital stay were also shorter following laser enucleation. At 6 months, mean IPSS was comparable between the groups (6.3 ± 2.2 vs. 6.9 ± 2.4; p=0.219), whereas Qmax was significantly higher following laser enucleation (24.0 ± 4.5 vs. 22.1 ± 4.2 mL/s; p=0.041).

Conclusion: It is concluded that both TURP and laser enucleation provide effective symptom relief in patients with BPH. Laser enucleation was associated with lower blood loss, shorter postoperative recovery, and greater improvement in urinary flow, although it required a longer operative time.