Introduction: Holmium Laser enucleation of Prostate (HoLEP) and open simple prostatectomy (OSP) are recommended treatments for large benign prostate hyperplasia (BPH). Robot-assisted simple prostatectomy (RASP) seems comparable to open simple prostatectomy (OSP) in terms of efficacy and safety, providing similar improvements in Qmax and IPSS, but with advantages of minimally invasive technique. It remains unclear which is the best treatment between HoLEP and RASP. The aim of the study was to compare these techniques in terms of perioperative data, short-term functional outcomes in patients (pts) with prostate larger than 100 cc. Methods: From January 2016 to January 2022, data from 94 pts with BPH>100 cc who underwent HoLEP or RASP were retrospectively analyzed. Overall, 47 pts underwent HoLEP and 47 underwent RASP. Operative time (OT), blood loss evaluated as ?Hb, length of catheterization (LOC), length of stay (LOS), IPSS, quality of life (QoL) index, urgency, maximum flow rate (Qmax), PSA, complications and urinary continence were analyzed at 30 and 90 days after surgery. Statistical analysis was made with T-test or Wilcoxon test for parametric and non-parametric continuous variables, respectively. Chi-square test was used for percentage variables. Statistical significance was set at p<0.05. Results: The groups were comparable in terms of age, BMI, pre-operative IPSS and QoL index. The mean prostate volume was similar even if in HoLEP group was slightly lower (128.4±23.9 vs 144±34.1 cc, p>0.05). LOC (2.4±0.9 vs 4.5±1.5 days, p=0.003) and LOS (3.5±1.1 vs 5±1.8 days, p=0.002) were significantly shorter for HoLEP group. No differences were observed in post-operative ?Hb, QoL, IPSS, urgency and urinary continence at 30 and 90 days after surgery. Otherwise, OT of RASP was significantly lower than HoLEP (107,5±20,1 vs 178,9±62 min, p<0.05), while at 3 months Qmax and PSA value were higher and lower, respectively, in HoLEP group (33.2±12.4 vs 24.5±15.3 ml/sec, p=0.03 and 0.8± vs 1.6± ng/ml, p=0.003). No intraoperative complication according to EAUiaiC occurred and only minor postoperative complications according to Clavien Dindo classification were observed without significant differences (4,25% for HoLEP vs 10.6% for RASP, p=0.27). Conclusions: Compared to RASP, HoLEP shows advantages in reducing LOC and LOS, but needs of longer OT. Lower levels of PSA in HoLEP, that could be the result of more tissue removal, and the better Qmax do not affect IPSS and QoL in peri-operative and short-term outcomes. HoLEP and RASP are both safe and effective enucleative techniques. Probably, RASP could be more useful for pts with larger BPH and multiple vesical lithiasis or large diverticulum. SOURCE OF Funding: None
