Comparative outcomes of holmium laser enucleation of the prostate (HoLEP) versus robotic-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia: a systematic review and meta-analysis
Abstract
With the rising prevalence of benign prostatic hyperplasia (BPH), there is an increasing demand for surgical interventions that optimize patient outcomes while minimizing complications. This systematic review aims to critically evaluate and contrast the clinical outcomes, surgical efficiency, and safety profiles during the perioperative period for holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy (RASP) in patients diagnosed with BPH exhibiting a prostate volume of ≥ 80 mL, providing evidence-based insights for BPH management. Adhering to the EAU Guidelines Office and PRISMA guidelines, the study protocol was registered with Prospero [CRD420251059418]. A comprehensive literature search was conducted in Web of Science, Embase, PubMed and Scopus up to May 10, 2025, to identify comparative studies of HoLEP and RASP in BPH patients. The methodological quality of the included studies was systematically evaluated using the Newcastle–Ottawa Scale (NOS), a validated tool specifically designed to assess the risk of bias in observational studies. Eleven studies involving 1772 patients (1247 HoLEP; 525 RASP) met inclusion criteria. Both techniques demonstrated comparable efficacy in functional outcomes, including maximum urinary flow rate, post-void residual volume, International Prostate Symptom Score (IPSS), and quality of life (QoL). However, HoLEP exhibited superior efficiency metrics: Reduced estimated blood loss: 105.01 mL (p < 0.005);…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,772 participants or records.
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