COMPARATIVE ANALYSIS OF THE RESULTS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE AND OPEN PROSTATECTOMY IN THE SURGICAL TREATMENT OF BENIGN HYPER HYPERPLASIA OF THE PROSTATE GLAND, ПОРІВНЯЛЬНИЙ АНАЛІЗ РЕЗУЛЬТАТІВ ГОЛЬМІЄВОЇ ЛАЗЕРНОЇ ЕНУКЛЕАЦІЇ ПРОСТАТИ ТА ВІДКРИТОЇ ПРОСТАТЕКТОМІЇ ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ДОБРОЯКІСНОЇ ГІПЕРПЛАЗІЇ ПЕРЕДМІХУРОВОЇ ЗАЛОЗИ

<jats:p>ABSTRACT. Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms, including obstructive and irritative manifestations, as well as impaired urinary outflow due to bladder outlet obstruction, often requiring surgical treatment. According to the European Association of Urology (EAU, 2025) guidelines, in cases of significantly enlarged prostate volume (&gt;80 mL), open prostatectomy is considered the method of choice when laser enucleation of the prostate cannot be performed. However, open surgery is associated with greater tissue trauma, a higher rate of intraoperative and postoperative bleeding, increased complication rates, and longer hospital stay. To reduce adverse outcomes, holmium laser enucleation of the prostate (HoLEP) has been introduced into clinical practice.AIM. To evaluate and perform a comparative analysis of early (in-hospital) outcomes of simultaneous open transvesical prostatectomy and holmium laser enucleation of the prostate in the surgical treatment of large-volume benign prostatic hyperplasia (&gt;80 cm3).MATERIALS AND METHODS. In the Urology Department of the Vinnytsia Regional Clinical Hospital named after M.I. Pirogov, 100 open simultaneous transvesical prostatectomies and 100 simultaneous holmium laser enucleations of the prostate were performed during 2024–2025. HoLEP procedures were carried out using a MultiPulse HoPlus holmium laser system (150 W) with a MultiCut morcellator, a 600 μm laser fiber (Jena Surgical, Germany), and an Olympus 26F resectoscope. Intraoperative blood loss during open prostatectomy was measured by the gravimetric method, while in HoLEP it was assessed using a calorimetric method. Postoperative surgical complications were classified according to the Clavien–Dindo system. Functional urinary outcomes before and after surgery were evaluated using uroflowmetry by measuring maximum urinary flow rate (Qmax).RESULTS. The mean age of patients in the HoLEP group was 68.7±7.4 years, mean prostate volume was 93.9±39.5 cm3, mean operative time (enucleation and morcellation) was 67.2±17.4 minutes, mean intraoperative blood loss was 119.7±37.2 mL, and mean postoperative hospital stay was 6.2±2.9 days. In the open transvesical prostatectomy group, the mean patient age was 67.7±7.6 years, prostate volume 94.2 ±32.6 cm3, and mean operative time 68.3±12.7 minutes. Intraoperative blood loss was significantly higher, amounting to 252.7±23.2 mL (p&lt;0.05), and mean postoperative hospital stay was 9.3±1.9 days (p&lt;0.05). Postoperative opioid analgesia in the open surgery group required an average of 2.4 mL of morphine per patient, whereas no morphine was required after HoLEP. Complications after HoLEP included postoperative bleeding in 1% of cases, hyperthermia after catheter removal in 1%, and urinary incontinence in 4%. Blood transfusion was required in only one patient. After open prostatectomy, complications were more frequent: bleeding requiring blood component transfusion in 5%, hyperthermia in 5%, acute urinary retention in 1%, pneumonia in 1%, urinary incontinence in 2%, acute epididymo-orchitis in 2%, among others. No mortality was recorded in either group. The overall complication rate was 6% after HoLEP and 22% after open transvesical prostatectomy (p&lt;0.05). Qmax improved from 7.3±1.1 mL/s to 23.7±2.6 mL/s after HoLEP, and from 7.0±1.5 mL/s to 24.0±2.7 mL/s after open prostatectomy.CONCLUSIONS. Holmium laser enucleation of the prostate is associated with lower intraoperative blood loss, reduced pain intensity, fewer early postoperative complications, and shorter hospital stay compared to open prostatectomy. Both techniques demonstrate high efficacy in restoring urinary flow in patients with BPH based on uroflowmetry results. Further studies are required to evaluate long-term outcomes of HoLEP compared with transvesical prostatectomy and to assess functional results in the late postoperative period.</jats:p>