Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Patient Population
2.2. Statistical Analysis
2.3. Surgical Techniques
3. Results
3.1. Before PSM
3.2. After PSM
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Wei, J.T.; Calhoun, E.; Jacobsen, S.J. Urologic diseases in America project: Benign prostatic hyperplasia. J. Urol. 2005, 173, 1256–1261. [Google Scholar] [CrossRef]
- Reich, O.; Gratzke, C.; Bachmann, A.; Seitz, M.; Schlenker, B.; Hermanek, P.; Lack, N.; Stief, C.G.; Urology Section of the Bavarian Working Group for Quality Assurance. Mor-bidity, Mortality and Early Outcome of Transurethral Resection of the Prostate: A Pro-spective Multicenter Evaluation of 10,654 Patients. J. Urol. 2008, 180, 246–249. [Google Scholar] [CrossRef] [PubMed]
- Krambeck, A.E.; Handa, S.E.; Lingeman, J.E. Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J. Urol. 2013, 189 (Suppl. S1), S141–S145. [Google Scholar] [CrossRef] [PubMed]
- Elmansy, H.M.; Kotb, A.; Elhilali, M.M. Holmium laser enucleation of the prostate: Long-term durability of clinical outcomes and complication rates during 10 years of followup. J. Urol. 2011, 186, 1972–1976. [Google Scholar] [CrossRef] [PubMed]
- Michalak, J.; Tzou, D.; Funk, J. HoLEP: The gold standard for the surgical management of BPH in the 21(st) Century. Am. J. Clin. Exp. Urol. 2015, 3, 36–42. [Google Scholar] [PubMed]
- Cornu, J.N.; Ahyai, S.; Bachmann, A.; De La Rosette, J.; Gilling, P.; Gratzke, C.; McVary, K.; Novara, G.; Woo, H.; Madersbacher, S. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: An update. Eur. Urol. 2015, 67, 1066–1096. [Google Scholar] [CrossRef]
- Baumert, H.; Ballaro, A.; Dugardin, F.; Kaisary, A.V. Laparoscopic Versus Open Simple Prostatectomy: A Comparative Study. J. Urol. 2006, 175, 1691–1694. [Google Scholar] [CrossRef]
- Umari, P.; Fossati, N.; Gandaglia, G.; Pokorny, M.; De Groote, R.; Geurts, N.; Goossens, M.; Schatterman, P.; De Naeyer, G.; Mottrie, A. Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center. J. Urol. 2017, 197, 1108–1114. [Google Scholar] [CrossRef] [PubMed]
- Zhang, M.W.; El Tayeb, M.M.; Borofsky, M.S.; Dauw, C.A.; Wagner, K.R.; Lowry, P.S.; Bird, E.T.; Hudson, T.C.; Lingeman, J.E. Comparison of Perioperative Outcomes between Holmium Laser Enucleation of the Prostate and Robot-Assisted Simple Prostatectomy. J. Endourol. 2017, 31, 847–850. [Google Scholar] [CrossRef]
- Palacios, D.A.; Kaouk, J.; Abou Zeinab, M.; Ferguson, E.L.; Abramczyk, E.; Wright, H.C.; Pramod, N.; De, S. Holmium Laser Enucleation of the Prostate vs. Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands. Urology 2023, 181, 98–104. [Google Scholar] [CrossRef]
- Saitta, G.; Becerra, J.E.A.; del Álamo, J.F.; González, L.L.; Elbers, J.R.; Suardi, N.; Gómez-Sancha, F. ‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia. World J. Urol. 2019, 37, 2451–2458. [Google Scholar] [CrossRef]
- Wright, A. REDCap: A Tool for the Electronic Capture of Research Data. J. Electron. Resour. Med. Libr. 2016, 13, 197–201. [Google Scholar] [CrossRef]
- Mitropoulos, D.; Artibani, W.; Biyani, C.S.; Bjerggaard Jensen, J.; Rouprêt, M.; Truss, M. Validation of the Clavien–Dindo Grading System in Urology by the European Associa-tion of Urology Guidelines Ad Hoc Panel. Eur. Urol. Focus 2018, 4, 608–613. [Google Scholar] [CrossRef] [PubMed]
- Hodhod, A.; Oquendo, F.; Tablowski, T.; Abdul-Hadi, R.; Shahrour, W.; Kotb, A.; Prowse, O.; Elmansy, H. ‘Top-Down’ holmium laser enucleation of the prostate. Report of initial cases per-formed by a single surgeon. Arab. J. Urol. 2021, 19, 130–136. [Google Scholar] [CrossRef] [PubMed]
- Shahait, M.; Patel, K.; Na, S.; Kim, J.; El-Fahmawi, A.; Dobbs, R.W.; Lee, D.I. Stepwise De-scription and Outcomes of Bladder Neck Sparing Robot-Assisted Simple Prostatectomy. J. Endourol. 2020, 34, 588–593. [Google Scholar] [CrossRef]
- Van Velthoven, R.F.; Ahlering, T.E.; Peltier, A.; Skarecky, D.W.; Clayman, R.V. Technique for laparoscopic running urethrovesical anastomosis: The single knot method. Urology 2003, 61, 699–702. [Google Scholar] [CrossRef]
- Shahait, M.; Yezdani, M.; Katz, B.; Lee, A.; Yu, S.J.; Lee, D.I. Robot-Assisted Transversus Abdominis Plane Block: Description of the Technique and Comparative Analysis. J. Endourol. 2019, 33, 207–210. [Google Scholar] [CrossRef] [PubMed]
- Assmus, M.A.; Large, T.; Lee, M.S.; Agarwal, D.K.; Rivera, M.E.; Krambeck, A.E. Same-Day Discharge following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc). J. Endourol. 2021, 35, 1386–1392. [Google Scholar] [CrossRef] [PubMed]
- Cho, M.C.; Park, J.H.; Jeong, M.S.; Yi, J.; Ku, J.H.; Oh, S.J.; Kim, S.W.; Paick, J. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol. Urodyn. 2011, 30, 1343–1349. [Google Scholar] [CrossRef]
- Kowalewski, K.F.; Hartung, F.O.; Von Hardenberg, J.; Haney, C.M.; Kriegmair, M.C.; Nuhn, P.; Patroi, P.; Westhoff, N.; Honeck, P.; Herrmann, T.R.W.; et al. Robot-Assisted Simple Prostatectomy vs Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-Analysis of Comparative Trials. J. Endourol. 2022, 36, 1018–1028. [Google Scholar] [CrossRef]
- Ramos-Carpinteyro, R.; Ferguson, E.L.; Chavali, J.S.; Geskin, A.; Soputro, N.; Kaouk, J. Sin-gle-port Transvesical Robot-assisted Radical Prostatectomy: The Surgical Learning Curve of the First 100 Cases. Urology 2023, 178, 76–82. [Google Scholar] [CrossRef] [PubMed]
- Abdul-Muhsin, H.M.; Tyson, M.D.; Andrews, P.E.; Castle, E.P.; Ferrigni, R.G.; Wolter, C.E.; Swanson, S.K.; McLemore, R.Y.; Humphreys, M.R. Analysis of benign prostatic hyperplasia patients’ perspective through a third par-ty-administered survey. Urology 2016, 88, 155–160. [Google Scholar] [CrossRef] [PubMed]
- Wymer, K.M.; Narang, G.; Slade, A.; Sharma, V.; Thao, V.; Borah, B.J.; Rivera, M.; Cheney, S.; Humphreys, M.R. Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia. Urology 2023, 171, 96–102. [Google Scholar] [CrossRef] [PubMed]
Variable | HoLEP (n = 156) | RASP (n = 36) | p Value |
---|---|---|---|
Age, years, mean ± SD n1 = 156; n2 = 36 | 72.93 ± 8.82 | 70.86 ± 8.2 | 0.2 |
BMI, kg/m2, median (IQR) n1 = 156; n2 = 36 | 26.1 (24.1–30.2) | 28.4 (24.7–31) | 0.136 |
Previous interventions for enlarged prostate, n (%) n1 = 156; n2 = 36 | |||
Yes | 42 (26.9%) | 7 (19.4%) | 0.404 |
No | 114 (73.1%) | 29 (80.6%) | |
Preop use of alpha-blockers, n (%) n1 = 156; n2 = 36 | |||
Yes | 114 (73.1%) | 27 (75%) | 0.839 |
No | 42 (26.9%) | 9 (25%) | |
Preop use of 5 ARIs, n (%) n1 = 156; n2 = 36 | |||
Yes | 66 (42.3%) | 17 (47.2%) | 0.709 |
No | 90 (57.7%) | 19 (52.8%) | |
Preop urinary retention, n (%) n1 = 156; n2 = 36 | |||
Yes | 82 (52.6%) | 20 (55.6%) | 0.853 |
No | 74 (47.4%) | 16 (44.4%) | |
Preop AUASS, mean ± SD n1 = 44; n2 = 22 | 17.8 ± 7.6 | 21.2 ± 7.3 | 0.086 |
Prostate size, mL, median (IQR) n1 = 125; n2 =36 | 84 (54.5–120) | 141.5 (104–158) | <0.001 |
Preop PVR, mL, median (IQR) n1 = 87; n2 = 17 | 150 (50–350) | 124 (28.5–454.5) | 0.626 |
ASA score, n (%) n1 = 156; n2 = 36 | |||
≤2 | 81 (51.9%) | 18 (50%) | 0.855 |
≥3 | 75 (48.1%) | 18 (50%) | |
Operation time, minutes, median (IQR) n1 = 156; n2 = 36 | 109.5 (77–134) | 131 (116.25–144.25) | <0.001 |
EBL, mL, median (IQR) n1 = 156; n2 = 36 | 25 (20–50) | 100 (50–100) | <0.001 |
Perioperative complications, n (%) n1 = 156; n2 = 36 | 0 | 0 | - |
Length of hospital stay, days, median (IQR) n1 = 156; n2 = 36 | 1 (0) | 0 (0) | <0.001 |
Postop complications, n (%) n1 = 156; n2 = 36 | 22 (14.1%) | 4 (11.1%) | 0.790 |
Clavien-Dindo Grade, n (%) ≥III | 7 (4.5%) | 3 (8.3%) | 0.401 |
Postop PSA, ng/mL, median (IQR) n1 = 84; n2 = 28 | 0.56 (0.3–1.32) | 0.8 (0.44–1.89) | 0.095 |
Length of catheterization, days, median (IQR) n1 = 156; n2 = 36 | 1 (1–4) | 7 (7–8) | <0.001 |
Readmission in 30 days, n (%) n1 = 156; n2 = 36 | 5 (3.2%) | 2 (5.6%) | 0.617 |
Readmission in 90 days, n (%) n1 = 156; n2 = 36 | 6 (3.8%) | 4 (11.1%) | 0.094 |
Pathology, n (%): n1 = 156; n2 = 36 | |||
Benign | 128 (82.1%) | 34 (94.4%) | 0.076 |
Cancer | 28 (17.9%) | 2 (5.6%) | |
Incidental prostate cancer | 22 (14.8%) | 1 (2.9%) | 0.084 |
Pathological weight of resected adenoma, grams, median (IQR) n1 = 156; n2 = 36 | 40 (15.5–71.2) | 72.8 (56.1–99.2) | <0.001 |
Postop PVR, mL, n (%): n1 = 87; n2 = 12 | |||
≤50 | 61 (70.1%) | 11 (91.7%) | 0.171 |
>50 | 26 (29.9%) | 1 (8.3%) | |
Postop 3-month AUASS, n (%): n1 = 32; n2 = 21 | |||
≤7 | 30 (93.8%) | 13 (72.2%) | 0.083 |
≥8 | 2 (6.3%) | 5 (27.8%) | |
SUI at postop 3 months, n (%): n1 = 149; n2 = 29 | |||
Yes | 8 (5.4%) | 2 (6.9%) | 0.668 |
No | 141 (94.6%) | 27 (93.1%) | |
Data available from: n1 -> HoLEP; n2 -> RASP |
Variable | HoLEP (n = 31) | RASP (n = 31) | p Value |
---|---|---|---|
Age, years, mean ± SD n1 = 31; n2 = 31 | 70 ± 8.1 | 71 ± 8.2 | 0.385 |
BMI, kg/m2, median (IQR) n1 = 31; n2 = 31 | 26.1 (24.5–28.8) | 28.4 (24.4–30.9) | 0.360 |
Previous interventions for enlarged prostate, n (%) n1 = 31; n2 = 31 | 8 (25.8%) | 6 (19.4%) | 0.762 |
Preop use of alpha-blockers, n (%) n1 = 31; n2 = 31 | 21 (67.7%) | 23 (74.2%) | 0.780 |
Preop use of 5 ARIs, n (%) n1 = 31; n2 = 31 | 9 (29%) | 15 (48.4%) | 0.192 |
Preop urinary retention, n (%) n1 = 31; n2 = 31 | 18 (58.1%) | 16 (51.6%) | 0.799 |
Preop AUASS, mean ± SD n1 = 12; n2 = 19 | 21 ± 9 | 20 ± 6 | 0.707 |
Prostate size, ml, mean ± SD n1 = 31; n2 = 31 | 117 (95–160) | 134 (103–154) | 0.335 |
Preop PVR, mL, median (IQR) n1 = 17; n2 = 14 | 109 (68–169) | 287 (88–457) | 0.186 |
ASA score, n (%) n1 = 31; n2 = 31 | |||
≤2 | 23 (74.2%) | 15 (48.4%) | 0.037 |
≥2 | 8 (25.8%) | 16 (51.6%) | |
Operation time, minutes, mean ± SD n1 = 31; n2 = 31 | 139 ± 34 | 128 ± 23 | 0.140 |
EBL, mL, median (IQR) n1 = 31; n2 = 31 | 40 (20–50) | 100 (50–100) | <0.001 |
Perioperative complications, n (%) n1 = 31; n2 = 31 | 0 | 0 | - |
Length of hospital stay, days, median (IQR) n1 = 31; n2 = 31 | 1 (1–2) | 0 (0) | <0.001 |
Postop complications, n (%) n1 = 31; n2 = 31 | 5 (16.1%) | 3 (9.7%) | 0.707 |
Postop PSA, ng/mL, median (IQR) n1 = 13; n2 = 25 | 0.8 (0.5–1.53) | 0.8 (0.45–2.03) | 0.879 |
Length of catheterization, days, median (IQR) n1 = 31; n2 = 31 | 1 (1–4) | 7 (7–8) | <0.001 |
Readmission in 30 days, n (%) n1 = 31; n2 = 31 | 3 (9.7%) | 2 (6.5%) | 1 |
Readmission in 90 days, n (%) n1 = 31; n2 = 31 | 3 (9.7%) | 4 (12.9%) | 1 |
Pathology, n (%): n1 = 31; n2 = 31 | |||
Benign | 26 (83.9%) | 29 (93.5%) | 0.425 |
Cancer | 5 (16.1%) | 2 (6.5%) | |
Incidental prostate cancer | 4 (13.3%) | 1 (3.3%) | 0.353 |
Pathological weight of resected adenoma, grams, mean ± SD n1 = 31; n2 = 31 | 78.5 ± 36.4 | 70.9 ± 32 | 0.394 |
Postop PVR, mL, n (%): n1 = 19; n2 = 11 | |||
≤50 | 13 (68.4%) | 10 (90.9%) | 0.215 |
>50 | 6 (31.6%) | 1 (9.1) | |
Postop 3-month AUASS, n (%): n1 = 18; n2 = 18 | |||
≤7 | 17 (94%) | 14 (78%) | 0.338 |
≥8 | 1 (6%) | 4 (22%) | |
SUI at postop 3 months, n (%): n1 = 28; n2 = 25 | |||
Yes | 2 (7%) | 2 (8%) | 1 |
No | 26 (93%) | 23 (92%) | |
Data available from: n1 -> HoLEP; n2 -> RASP |
Variable | HoLEP (n = 31) | RASP (n = 31) | p Value |
---|---|---|---|
Readmission in 90 days, n (%) n1 = 31; n2 = 31 | 3 (9.7%) | 4 (12.9%) | 1 |
Reasons for readmission |
|
|
Pre-PSM Outcomes | OR | 95% CI | p-Value |
AUASS at 3 months | 0.173 | 0.03–1.01 | 0.052 |
SUI rates at 3 months | 0.77 | 0.15–3.8 | 0.744 |
Complication rates | 1.31 | 0.42–4.1 | 0.637 |
Post-PSM Outcomes | OR | 95% CI | p-Value |
AUASS at 3 months | 0.235 | 0.022–2.54 | 0.124 |
SUI rates at 3 months | 0.89 | 0.12–6.79 | 0.906 |
Complication rates | 1.8 | 0.39–8.277 | 0.453 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Khanmammadova, N.; Jiang, J.F.; Gomez, R.K.M.; Gao, A.; Chu, T.Y.; Shahait, M.; Myklak, K.; Lee, D.I.; Das, A.K. Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy. J. Clin. Med. 2024, 13, 5135. https://doi.org/10.3390/jcm13175135
Khanmammadova N, Jiang JF, Gomez RKM, Gao A, Chu TY, Shahait M, Myklak K, Lee DI, Das AK. Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy. Journal of Clinical Medicine. 2024; 13(17):5135. https://doi.org/10.3390/jcm13175135
Chicago/Turabian StyleKhanmammadova, Narmina, James F. Jiang, Ralph Kevin Medina Gomez, Ashley Gao, Timothy Young Chu, Mohammed Shahait, Kristene Myklak, David I. Lee, and Akhil K. Das. 2024. "Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy" Journal of Clinical Medicine 13, no. 17: 5135. https://doi.org/10.3390/jcm13175135