Retrospective comparison of pathology results of benign prostatic hyperplasia patients who had undergone transurethral prostate resection, prostate enucleation or open prostatectomy

Aim: Our study aims to reveal the incidental oncological diagnosis rates of patients who underwent HoLEP, open prostatectomy and TUR-P and which clinical parameters this may be related to. Materials and Methods: A total of 771 patients who were treated at the Hacettepe University Urology Department between January 2021 and October 2023, who were given a surgical indication due to BPH despite medical treatment, and who underwent Open Prostatectomy, TUR-P or HoLEP surgeries were included in our study. Patients diagnosed with prostate cancer before surgery were excluded from the study. The patients' age, pre-operative PSA values, prostate volumes and prostate specimen volumes included in the study by Pathology were taken as parameters and compared between the surgery groups. In addition, PSA densities, resected prostate volumes and pre-operative and post-operative IPSS scores were also included in the comparison. Results: 310 HoLEP, 106 SPTV-P and 355 TUR-P patients were included in the study. When the homogeneity between the groups was examined for comparison, it was understood that the SPTV-P group was statistically significantly higher than the other two groups with a mean of 70.1 in terms of age; however, in the eta squared evaluation made for statistical power, this difference was understood to be below moderate significance. In the comparison made in terms of PSA and pre-operative prostate volume, the SPTV-P group was found to be statistically significantly different, and it was found to be compatible with our clinical practice, together with the frequent referral of patients with larger prostates (>100 g) to SPTV-P during pre-operative patient evaluation. PSA density between the groups was compared and no significant difference was found. In the correlation analyses between the groups, a strong correlation was found between PSA and prostate volume in the total cohort and in the internal examination of all three groups; it was seen that the trend arising from this correlation disappeared in patients diagnosed with malignancy. In the comparison made between the groups, incidental prostate cancer was detected in 6.6% of the total cohort. In multiple and binary analyses between the groups, it was observed that there was no statistically significant difference in terms of iPca detection rates. iPca was detected in 5.5% of patients in the HoLEP group, 3.8% in the SPTV-P group, and 7.9% in the TUR-P group. When the significance level of the parameters in terms of iPca detection was examined, it was calculated that age and the specimen volume included in the study by Pathology created statistically significant results. It was found that the PSAd value of the patient group diagnosed with iPca was 0.13 on average, and the PSAd average of xi the patients diagnosed benign was 0.06; the difference between them was found to be statistically significant. In addition, analysis was performed for patients whose IPSS scores were determined pre-operatively and at the 3rd month post-operatively within the three surgery groups, and it was determined that there was a statistically significant improvement in IPSS for all three surgery types; and no superiority between the three groups. Conclusion: According to our results, HoLEP surgery is reliable in oncological terms, despite offering different specimen morphology. iPca detection rates are mainly related to patient age and prostate specimen volume examined by Pathology. Keywords: Prostate, Holmium laser prostate enucleation, open prostatectomy, incidental prostate cancer, prostate volume