Comparative evaluation of clinical efficacy, safety, and economic expenses of two endoscopic techniques for treating prostatic hyperplasia in elderly patients

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctor’s task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients’ lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness.

Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (>60 years old).

Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume >40 cm3, maximum urine flow <15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators “cost-effectiveness”, “cost-utility”, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model.

Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group.

Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patient’s recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

Full Text

Restricted Access

About the authors

Kirill S. Peshekhonov

North-Western State Medical University named after I.I. Mechnikov; Saint Petersburg Alexander City Hospital

Author for correspondence.
ORCID iD: 0000-0003-2196-3175

Russian Federation, Saint Petersburg

врач-уролог отделения урологии 

Eugene S. Shpilenia

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0003-0479-6555

Russian Federation, Saint Petersburg

д.м.н., профессор кафедры урологии

B. K. Komyakov

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-8606-9791

Russian Federation, Saint Petersburg

д.м.н., профессор; заведующий кафедры урологии

Oleg O. Burlaka

North-Western State Medical University named after I.I. Mechnikov; Saint Petersburg Alexander City Hospital

ORCID iD: 0000-0001-6405-9405

Russian Federation, Saint Petersburg

Candidate of Medical Science, Head of Department of Urology

Natalia V. Morozova

Saint Petersburg State Forestry University

ORCID iD: 0000-0001-9663-7484

Russian Federation, Saint Petersburg

к.э.н., доцент кафедры экономики, учета и анализа хозяйственной деятельности 


  1. Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017;4(3):148-151.
  2. Винник Ю.Ю., Андрейчиков А.В., Климов Н.Ю. Современное представление о диагностике гиперплазии простаты // Урология. – 2018. – № 2. – С. 124–129. [Vinnik YuYu, Andreychikov AV, Klimov NYu. Current concept of diagnosis of benign prostatic hyperplasia. Urologiia. 2018;(2):124-129. (In Russ.)]. 10.18565/urology.2018.2.124-129.
  3. Lokeshwar SD, Harper BT, Webb E, et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019;8(5):529-539. tau.2019.10.01.
  4. Bahia LR, Araújo DV, Pepe C, et al. Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system. Int Braz J Urol. 2012;38(5):595-605.
  5. Еникеев Д.В., Глыбочко П.В., Аляев Ю.Г., и др. Эндоскопическая энуклеация предстательной железы — новый стандарт хирургического лечения гиперплазии предстательной железы // Андрология и генитальная хирургия. – 2017. – Т. 18. – № 3. – С. 83–88. [Enikeev DV, Glybochko PV, Alyaev YuG, et al. Endoscopic enucleation of the prostate — a new standard in surgical treatment of benign prostatic hyperplasia. Andrology and genital surgery. 2017;18(3):83-88. (In Russ.)].
  6. Ahyai SA, Gilling P, Kaplan SA, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384-397. 2010.06.005.
  7. Аль-Шукри С.Х., Гиоргобиани Т.Г., Амдий Р.Э., Аль-Шукри А.С. Нарушения мочеиспускания у больных с неудовлетворительными результатами хирургического лечения доброкачественной гиперплазии предстательной железы // Вестник хирургии имени И.И. Грекова. – 2017. – T. 176. – № 6. – C. 66–70. [Al-Shukri SKh, Giorgobiani TG, Amdiy RE, Al-Shukri AS. Urinary dysfunction in patients with unsatisfactory results of surgical treatment of benign prostatic hyperplasia. Grekov’s bulletin of surgery. 2017;176(6):66-70. (In Russ.)].
  8. Reich O, Seitz M, Gratzke C, et al. Benign prostatic hyperplasia (BPH): Surgical therapy options. Urologe A. 2010;49(1):113-126. 2183-1.
  9. Ulchaker JC, Martinson MS. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Clinicoecon Outcomes Res. 2017;10:29-43.
  10. Alpert JS. Compliance/adherence to physician-advised diagnostic and therapeutic strategies. Am J Med. 2014;127(8):685-686. 2014.03.010.
  11. Disantostefano RL, Biddle AK, Lavelle JP. An evaluation of the economic costs and patient-related consequences of treatments for benign prostatic hyperplasia. BJU Int. 2006;97(5):1007-1016.
  12. Kovács Á. Cost of illness in benign prostatic hyperplasia: A review. Society and Economy. Corvinus. 2015;37(4):531-542.
  13. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67(6):1099-1109.
  14. Wolak T, Toledano R, Novack V, et al. Doxazosin to treat hypertension: It’s time to take it personally — a retrospective analysis of 19,495 patients. J Hypertens. 2014;32(5):1132-1137. 0000000000000119.
  15. Мартов А.Г., Максимов В.А., Яровой С.Ю., и др. Трансуретральная гольмиевая энуклеация аденомы предстательной железы // Урология. – 2011. – № 1. – С. 38–43. [Martov AG, Maksimov VA, Yarovoy SYu, et al. Transurethral holmium enucleation of prostatic adenoma. Urologiia. 2011;(1):38-43. (In Russ.)]

Supplementary files

Supplementary Files Action
Fig. 1. The stage of bipolar transurethral resection of the prostate

Download (71KB) Indexing metadata
Fig. 2. Initial incision stage in holmium laser enucleation of the prostate

Download (117KB) Indexing metadata
Fig. 3. Markov chain element in cost-effectiveness analysis

Download (360KB) Indexing metadata



Abstract - 53

PDF (Russian) - 4


Article Metrics

Metrics Loading ...




  • There are currently no refbacks.

Copyright (c) 2020 Peshekhonov K.S., Shpilenia E.S., Komyakov B.K., Burlaka O.O., Morozova N.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies