Xiaoming Hao, a urologist at Heping Hospital in Changzhi, China, has helped settle a long-standing surgical question: when it comes to treating enlarged prostates, both robot-assisted surgery and laser treatment work. A sweeping review of 15 studies involving over 2,200 patients, published in Frontiers in Medicine in May, shows that robot-assisted simple prostatectomy and laser enucleation of the prostate are both genuinely safe and effective options for men with large-volume benign prostatic hyperplasia—a common condition that makes urination difficult as men age.
For decades, urologists have debated the best way forward when a man's prostate grows too large. Surgery becomes necessary when medications fail, but which approach causes fewer complications and delivers better results? Hao's team examined data from 763 patients who underwent robot-assisted surgery and 1,468 who had laser treatment, looking closely at operating times, hospital stays, complication rates, and long-term symptom relief.
The findings reveal distinct trade-offs worth understanding. Laser enucleation was quicker—patients spent less time in the operating room and had their catheters removed sooner. Using a thulium fiber laser, doctors could also send patients home about 2.4 days earlier on average. But robot-assisted surgery came out ahead in unexpected ways. Men who chose robotic surgery experienced significantly less urinary incontinence afterward—the chance of leakage dropped by roughly half compared to laser patients. More strikingly, the robotic approach delivered superior long-term improvement in symptom scores, with the advantage becoming even clearer when researchers looked at patients 12 months after surgery.
Complication rates painted a similar picture: both procedures were comparably safe. Serious infections and other major complications occurred at similar rates. For day-to-day quality of life measures like maximum urinary flow rate, the two approaches performed equally well. Neither method emerged as the clear winner across all fronts—a reality that Hao's team emphasizes matters tremendously for actual patients and their doctors.
This nuance sits at the heart of modern surgical medicine. The researchers note that their conclusions come with important caveats: many of the underlying studies were retrospective, meaning researchers looked backward at medical records rather than following patients forward in controlled trials. There was also significant variation in how different hospitals conducted these procedures, which introduces uncertainty. The team urges surgeons and patients not to treat this as a rigid rulebook but rather as a framework for informed conversation.
What emerges is a picture of personalized choice. A man who wants to go home faster and spend minimal time under anesthesia might favor laser treatment. One concerned about long-term incontinence or committed to maximizing symptom relief over months and years might opt for robotic surgery. Age, overall health, preferences about recovery time, and personal risk tolerance all matter. The fact that both approaches work safely means that men with enlarged prostates now have genuine options tailored to their own priorities—a meaningful shift from an era when only one approach dominated.
This kind of comparative evidence, even with its limitations, helps close the gap between what we hope works and what actually does.