Purpose To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. Methods A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Q max ). Results Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Q max , PVR, IPSS and QoL score during follow-up. Conclusion ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference.

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It has been demonstrated that in an adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5F UT-URS without any need for dilation. At the same time, use of 4.5F UT-URS resulted in an acceptable treatment success and lower complication rates in most of these patients without the need for a second session.

Objective: We aimed to investigate the safety and success of the holmium laser enucleation of prostate (HoLEP) surgery in patients with metabolic syndrome (MS) versus those without MS who have similar prostate sizes. Material and methods: Data from 120 patients who underwent HoLEP by a single surgeon between November 2015 and January 2018 were prospectively analyzed. Group 1 (n=40) and Group 2 (n=80) consisted of patients with and without MS, respectively. Preoperative-and postoperative third month control variables that were compared between the groups included hemoglobin (Hb) level; International Prostate Symptom Score (IPSS); uroflowmetry parameters, such as maximum flow rate (Qmax) and average flow rate (Qave); post-voiding residue (PVR); voiding time (VT); and time to maximum flow rate (MVT). Results: For postoperative outcomes between the groups, only hospitalization time (HT) was significant among IPSS, Qmax, Qave, PVR, VT, MVT, Hb decrease, and catheterization time (p= 0.03). A multivariate analysis showed that the triglyceride level positively correlated with HT among Group 1 patients (p= 0.03). Perioperative outcomes, such as enucleated tissue weight, efficiency of enucleation, enucleation rate, efficiency of morcellation, enucleation time, morcellation time, total operation time, total laser energy, and laser efficiency, were compared as non-significant between the two groups (p>0.05). Conclusion: We found that HoLEP can be considered a safe and effective surgical treatment for patients with MS.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is becoming the new standard procedure for treating benign prostatic hyperplasia (BPH), a common condition in aging men. Most studies have focused on proving its efficacy in treating large prostates. In this study, we compared its efficacy in treating small (< 80 mL) and large (> 80 mL) prostates. Methods: This prospective study included 119 patients with BPH who underwent HoLEP by the same surgeon between June 2015 and December 2017. They were divided into 2 groups according to their prostate volumes (≤80 mL: Group 1; > 80 mL: Group 2). Various pre- and postoperative parameters were compared within and between the groups. Results: International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, and voiding time (VT) significantly decreased, and the peak urinary flow rate (Qmax), average urinary flow rate (Qave), and quality of life (QoL) score significantly increased postoperatively in both groups. The postoperative changes in IPSS, QoL score, Qmax, Qave, VT, PVR volume, and hemoglobin levels were not significantly different between the groups. In addition, no significant difference was observed in postoperative complications between the groups. Conclusions: Our results indicate that HoLEP is an effective procedure for treating both small and large prostates.