Search Results (42)

Background: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgery for BPH. Thulium-based techniques (ThuLEP/ThuFLEP) are increasingly used for their cutting/coagulation benefits, but their comparative outcomes versus HoLEP remain uncertain. Methods: Our synthesis relied solely on RCT data comparing ThuLEP/ThuFLEP versus HoLEP for BPH. Eligible studies were RCTs directly comparing ThuLEP or ThuFLEP with HoLEP. Results: Eight RCTs involving 1196 patients were included. Compared with HoLEP, thulium laser enucleation demonstrated similar perioperative outcomes, with no statistically significant differences observed in operative time, enucleated tissue weight, hospital stay, or catheterization time. Postoperative hemoglobin decrease was comparable between the two groups (MD −0.34, 95% CI −0.69 to 0.01, p = 0.05). Subgroup analyses indicated that ThuLEP might be associated with potential advantages in postoperative hemoglobin decrease and transient urinary incontinence; however, these findings require cautious interpretation due to limited sample sizes and heterogeneity among studies. No significant differences were identified in postoperative complications or functional recovery outcomes. Conclusions: Current evidence from RCTs indicates that thulium laser enucleation techniques and HoLEP provide similar efficacy and safety outcomes for patients undergoing surgical treatment of BPH. Full article

Background/Objectives: Depression is a frequently overlooked but clinically important complication following surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to compare the risk of new-onset postoperative depression following transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in patients with BPH. Methods: We conducted a retrospective cohort study using the Korean Health Insurance Review and Assessment database. Patients diagnosed with BPH between 2013 and 2022 who underwent TURP or HoLEP and had no prior diagnosis of a psychiatric disorder were included (n = 30,878 and n = 21,521, respectively). The primary outcome was a diagnosis of depression within one year after surgery. Multivariable logistic regression and propensity score matching were used to adjust for covariates, including age, comorbidities, medication use, geographic region, and hospital level. Sensitivity analyses were conducted using follow-up periods of one, three, six, and nine months. Results: In the unadjusted model, HoLEP was associated with higher odds of postoperative depression compared with TURP (odds ratio [OR] = 1.338, 95% confidence interval [CI]: 1.245–1.438; p < 0.0001). This association remained significant after multivariable adjustment (OR = 1.350, 95% CI: 1.255–1.451; p < 0.0001) and propensity score matching (OR = 1.364, 95% CI: 1.259–1.476; p < 0.0001). The association was observed across alternative follow-up windows in the sensitivity analyses. Conclusions: HoLEP is associated with higher odds of new-onset postoperative depression compared with TURP. These findings may inform perioperative mental health assessment for patients undergoing surgical treatment for BPH, and warrant further evaluation to establish causality or clarify the underlying mechanism. Full article

Introduction/Background: Large-volume benign prostatic hyperplasia (≥80 mL) requires complete anatomical removal of the adenoma. Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their comparative perioperative performance in very large glands remains incompletely defined. Objective: To systematically review and quantitatively synthesize the perioperative outcomes and complications of RASP/MISP versus AEEP in the surgical management of large-volume BPH. Methodology: Following PRISMA 2020, PubMed, Embase, Scopus and the Cochrane Library were searched from inception to 7 June 2026 for randomized and non-randomized comparative studies of RASP/MISP versus AEEP in men with mean or median prostate volume ≥ 80 mL reporting at least one perioperative or functional outcome and at least one Clavien–Dindo grade ≥ III complication. Continuous outcomes were pooled as mean differences (MD) and dichotomous outcomes as risk ratios using random-effects models (REML with Knapp–Hartung adjustment); heterogeneity was assessed with I². Risk of bias was evaluated with the Newcastle–Ottawa Scale and ROBINS-I, and certainty of evidence with GRADE. Publication bias and leave-one-out sensitivity analyses were performed where the number of studies permitted. Results: Five comparative cohort studies published between 2017 and 2025 were included, comprising 271 patients treated with RASP/MISP and 998 treated with AEEP. AEEP was associated with a significantly shorter catheterization time (pooled MD 5.95 days; 95% CI 1.98–9.92; p = 0.014) and a shorter hospital stay (pooled MD 2.73 days; 95% CI 1.07–4.39; p = 0.010), both with high heterogeneity (I² 99.0% and 96.1%, respectively). Perioperative hemoglobin drop tended to favor AEEP without reaching significance (pooled MD 0.65 g/dL; 95% CI −0.33 to 1.63; p = 0.103), and transfusion risk was lower but not statistically significant (pooled RR ≈ 0.46; 95% CI 0.18–1.15). PSA reduction was substantial and broadly equivalent between techniques. Functional outcomes (IPSS, QoL, Qmax, PVR) improved comparably with both approaches. Leave-one-out analyses confirmed that the catheterization and length-of-stay advantages of AEEP were robust, and no evidence of publication bias was detected. Certainty of evidence was low to moderate, reflecting the observational designs. Leave-one-out analyses indicated that the catheterization and length-of-stay differences were not driven by any single study; publication bias could not be assessed reliably because fewer than ten studies contributed to any outcome. Certainty of evidence was low to moderate, reflecting the observational designs, the small number of studies, and substantial between-study heterogeneity, and the findings should be regarded as hypothesis-generating. Conclusions: In large-volume BPH, AEEP and RASP/MISP achieve comparable functional improvement and adenoma debulking, but AEEP offers superior perioperative efficiency, with markedly shorter catheterization and hospital stay and at least comparable safety. RASP/MISP remains a valuable option where robotic infrastructure is available but high-volume enucleation expertise is lacking. These findings, drawn from observational evidence of low-to-moderate certainty, support AEEP as the more resource-efficient minimally invasive option for very large glands and underline the need for randomized comparative trials. Full article

Background/Objectives: Variations in urinary symptom improvement after benign prostatic hyperplasia (BPH) surgery remain incompletely characterized. Preoperative factors, including bowel dysfunction, may influence postoperative recovery. We evaluated the association between baseline bowel function and urinary outcomes after holmium laser enucleation of the prostate (HoLEP), hypothesizing that worse baseline constipation would be associated with poorer outcomes. Methods: A prospective cohort study of patients undergoing HoLEP by a single surgeon at a high-volume center (December 2023–September 2024) was performed. Patients with neurogenic bladders, bowel disorders, or diabetes mellitus were excluded. Baseline bowel function was assessed using the Constipation Scoring System (CSS) and Vaizey Incontinence Score (VIS). The primary outcomes were 3-month changes in International Prostate Symptom Score (IPSS) and Michigan Incontinence Severity Index (MISI). Associations were evaluated using Spearman correlation and multivariable linear regression. Results: Among 102 patients (median age of 71.6 years), 81 (79.4%) completed follow-up. The median prostate size was 90.5 cc, and 50% had prior urinary retention. The baseline CSS and VIS were low. IPSS, quality of life, and MISI bother improved postoperatively, while MISI severity showed minimal change. Higher CSS correlated with higher VIS (p < 0.001). Baseline CSS and VIS were not associated with changes in IPSS, quality-of-life (QoL), or MISI bother. Baseline VIS was associated with modest improvement in MISI severity (β −1.14, p = 0.01). Conclusions: Baseline bowel function was not associated with urinary symptom improvement after HoLEP. However, preoperative fecal incontinence was associated with improvement in urinary incontinence severity. Full article

Background/Objectives: Contemporary minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia carry retreatment rates up to 32%, with holmium laser enucleation of the prostate (HoLEP) increasingly used as salvage therapy. Prior reviews focused on salvage HoLEP (sHoLEP) following transurethral resection; however, technical challenges specific to the post-MIST field remain uncharacterised. We aimed to characterise technical barriers during sHoLEP following contemporary MISTs, with secondary evaluation of efficacy, safety and feasibility. Methods: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines (PROSPERO: CRD420261321711), five databases were searched from inception to February 2026. Studies reporting sHoLEP outcomes in adults with prior MIST were included. Qualitative findings were synthesised thematically; quantitative outcomes reported by three or more studies underwent random-effects meta-analysis. Risk of bias was assessed using methodological index for non-randomized studies methodological index for non-randomized studies (MINORS) and certainty of evidence using grading of recommendations, assessment, development, and evaluation (GRADE). Results: Ten studies (354 sHoLEP, 3618 primary HoLEP (pHoLEP) patients) were included. Technical difficulty was MIST-type dependent: thermoablative procedures and prostatic artery embolisation preserved the enucleation plane, while prostatic urethral lift (PUL) introduced morcellation-specific challenges including blade jamming and staged procedures. Meta-analysis revealed no difference in operative time or tissue weight, but reduced enucleation efficiency (weighted mean difference; WMD −0.11 g/min, p = 0.027) and peak urinary flow improvement (WMD −3.0 mL/s, p < 0.001). Both findings were sensitive to analysis, losing significance on restriction to predominantly MIST cohorts, and the enucleation efficiency result additionally lost significance on removal of the most heavily weighted study (p = 0.94). Complication rates were equivalent (odds ratio (OR) 0.92, p = 0.787). Conclusions: sHoLEP is safe and efficacious following contemporary MIST. Surgeons should anticipate MIST-specific challenges, particularly morcellation difficulties after PUL requiring tailored instrumentation. Prospective MIST-specific studies are needed. Full article

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

Background/Objectives: Obesity has been associated with the development and severity of benign prostatic hyperplasia (BPH), yet its influence on outcomes following definitive surgical management, like holmium laser enucleation of the prostate (HoLEP), remains unclear. Furthermore, gradation of body mass index (BMI) severity has yet to discern personalized outcome stratification. We evaluated BMI’s influence on perioperative, immediate, short-term follow-up, and patient-reported outcomes for HoLEP patients. Methods: We performed a retrospective review of a prospectively maintained database of patients undergoing HoLEP for BPH at a single institution between January 2021 and August 2025. Outcomes included operative characteristics, post-operative complications, and validated symptom score changes. Analyses treated BMI as both a continuous and categorical variable. Multivariable linear and logistic regression models adjusted for common colinear confounders. Results: Among 1445 patients, BMI was not associated with most immediate, three-month, or patient-reported outcomes. Surgical complications were low across all BMI categories, and post-operative reported outcomes indicating high success rate for HoLEP. Higher BMI correlated with a modest increase in enucleation time (β = 0.197; p = 0.0132), increased odds of dysuria (OR = 1.084; p < 0.001), and change in American Urological Association Symptom Score (β = 0.211; p = 0.0334). All other operative metrics, complication rates, continence outcomes, and symptom scores (17 other total) were independent of BMI. Conclusions: After adjustment for relevant confounders, BMI does not meaningfully predict surgical safety, functional recovery, or patient-reported benefit following HoLEP. BMI alone should not influence candidacy or risk stratification for HoLEP in patients with BPH, instead favoring personalized, risk-stratified approaches. Full article

Background: This retrospective matched-pair analysis compared functional outcomes and complications of prostate artery embolization (PAE) using 250 µm microparticles and holmium laser enucleation of the prostate (HoLEP) in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: A total of 69 PAE patients were matched 1:1 to 69 HoLEP patients using propensity scores based on age, prostate volume (PV), and IPSS. Follow-up was standardized at six months for the PAE cohort, while HoLEP outcomes were assessed cross-sectionally (median 52.9 months). All comparisons were therefore interpreted as cross-sectional analyses rather than time-matched outcomes. Secondary endpoints were complications according to the Clavien–Dindo Classification. Results: At baseline, there were no significant differences between PAE and HoLEP regarding IPSS, QoL, or Qmax. Both interventions led to significant within-group improvements in IPSS, QoL, and Qmax (p < 0.001). Between-group comparisons demonstrated significantly greater improvement in IPSS, Qmax, and QoL following HoLEP (all p < 0.05). Erectile function remained stable after PAE and showed a non-significant decrease after HoLEP. Severe complications (Clavien–Dindo ≥ Grade III) were not observed after PAE. These findings should be interpreted considering the study’s main limitations, including the small cohort size, its retrospective matched-pair design, and variability in surgeons’ HoLEP experience. Conclusions: PAE with 250 µm microparticles and HoLEP are both effective and safe procedures. While PAE compared to HoLEP is less effective regarding functional outcome, it showed no difference in QoL improvement and is associated with no greater grade II complications. Full article

Prostatic artery embolization (PAE) has emerged as a minimally invasive treatment for benign prostatic obstruction (BPO), offering clinically meaningful symptom improvement with a favorable perioperative safety and sexual function profile. This narrative review synthesizes the current evidence on PAE relative to transurethral resection of the prostate (TURP) and holmium laser enucleation (HoLEP), and other minimally invasive surgical treatments (MISTs). PAE generally offers a more favorable perioperative safety profile and shorter recovery time, at the cost of higher reintervention rates. PAE improves lower urinary tract symptoms, quality of life, and urinary flow; however, the magnitude of improvement is generally smaller than that observed in comparative studies with TURP and HoLEP. At the same time, PAE is consistently associated with fewer perioperative complications, shorter recovery time, and a significantly higher preservation of ejaculation function. Reintervention rates after PAE are significantly higher than those after TURP, reaching approximately one in five patients at 2 years and nearly half at 5 years in long-term randomized follow-up, suggesting limited long-term durability compared with resective surgery. This review summarizes current patient selection criteria, anatomic and technical considerations, embolization material choices, and clinical outcomes, and also presents comparative data with TURP, HoLEP, and GreenLight photoselective vaporization. Emerging technologies, including imaging guidance and AI-assisted planning, may further optimize patient selection and procedural consistency, but longer-term comparative trials and standardized protocols are needed. Overall, PAE offers an option for carefully selected patients who prioritize functional preservation or are at high surgical risk, with the added disadvantage of lower long-term durability compared to standard surgical approaches. Full article

Background: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 70–75% of newly diagnosed bladder cancers and is characterized by high recurrence rates despite guideline-based management. Chronic urinary retention and bladder outlet obstruction (BOO) have been proposed as under-recognized modifiers of NMIBC outcomes through prolonged exposure to urinary carcinogens, inflammation, and altered intravesical pharmacokinetics. This narrative review qualitatively synthesizes biological and clinical evidence linking BOO-related dysfunction with NMIBC behavior and explores the emerging, but preliminary, role of Holmium Laser Enucleation of the Prostate (HoLEP) as a functional adjunct in selected patients. Methods: A narrative review was conducted according to SANRA guidelines. PubMed/MEDLINE, Embase, and Scopus were searched (January 2000–October 2025) using predefined terms for NMIBC, BOO, urinary retention, and HoLEP. Two reviewers independently screened records, with disagreements resolved by consensus. Sixty-one studies met inclusion criteria. Results: Elevated postvoid residual (PVR) (>80–100 mL) and moderate to severe lower urinary tract symptoms (LUTS) were consistently associated with higher NMIBC recurrence rates, independent of tumor stage and grade, in heterogeneous cohorts. Retention correlated with reduced efficacy of Bacillus Calmette–Guérin (BCG) and mitomycin C, likely via uneven drug distribution and a chronically inflamed urothelium. Mechanistic data support a plausible link between BOO-related inflammation, barrier dysfunction, and tumor biology, although direct biomarker correlations with PVR or pharmacokinetic studies are lacking. HoLEP provides durable relief of BOO, reduces PVR, and improves LUTS. Limited retrospective data suggest an association between HoLEP and lower recurrence, but these observations are confounded and should be viewed as hypothesis-generating. Conclusions: Chronic urinary retention and BOO appear to be modifiable functional factors that may influence NMIBC recurrence and intravesical therapy performance. HoLEP is a promising option to optimize bladder emptying in carefully selected patients, but its oncologic impact remains unproven and should be considered hypothesis-generating pending prospective, risk-adjusted studies. Full article

Background and Objectives: Aquablation, a robot-assisted, heat-free resection technique, has emerged as a promising minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). Its precision and potential for preservation of sexual function distinguish it from traditional surgical options. This systematic review aimed to evaluate the safety profile of Aquablation, with emphasis on perioperative complications and functional outcomes. Materials and Methods: We systematically searched PubMed/MEDLINE, Scopus, and the Cochrane Library through June 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251074479). Eligible studies included randomized and non-randomized trials of Aquablation in men with BPH, reporting adverse events by type, frequency, or severity. Risk of bias was assessed with ROB-2 and ROBINS-I tools. Results: Forty-seven studies were included, spanning randomized controlled and prospective observational designs. Most complications were minor (Clavien-Dindo grade 1–2). Bleeding was the most frequent perioperative event, with transfusion required in 1–8% of cases, more often in large prostates. Severe complications (grade ≥ 3) were uncommon and usually related to bleeding or urinary retention. Long-term sequelae such as strictures or bladder neck contracture were rare. Compared with transurethral resection of the prostate, Aquablation yielded lower rates of ejaculatory dysfunction (10% vs. 36%), with continence and erectile function largely preserved. Outcomes were comparable to holmium laser enucleation, but Aquablation demonstrated superior ejaculatory preservation. Conclusions: Aquablation demonstrates a favorable safety profile across prostate sizes, with its greatest advantage being preservation of sexual function. While bleeding remains the principal perioperative concern, life-threatening events are rare. Further independent, long-term comparative studies are warranted. Full article

Background: The widespread adoption of holmium laser enucleation of the prostate (HoLEP) has led to a growing number of men subsequently diagnosed with localized prostate cancer requiring radical prostatectomy (RP). However, anatomical alterations after HoLEP may increase surgical complexity and affect outcomes. This systematic review aimed to synthesize current evidence on perioperative, oncological, and functional outcomes of RP following HoLEP. Methods: A systematic literature search was conducted in PubMed, CENTRAL, and ClinicalTrials.gov through to September 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251134483). Eligible studies included patients undergoing RP after HoLEP with reported perioperative, oncologic, or functional data. Methodological quality was assessed using the ROBINS-I tool, and results were synthesized narratively. Results: Eight retrospective studies comprising 202 patients were included. RP after HoLEP was technically feasible across open, laparoscopic, and robotic approaches. Operative time and the need for bladder-neck reconstruction were increased, reflecting post-enucleation fibrosis, but major complication rates (<5%) and blood loss were comparable to primary RP. Oncological outcomes were preserved, with positive surgical margin rates of 6–20% and biochemical recurrence rates of 7–15%, similar to those of primary RP. Functional recovery, particularly urinary continence, was slower initially but generally equivalent at 12 months. Erectile function outcomes were variable but satisfactory when nerve-sparing was feasible. Conclusions: Radical prostatectomy after HoLEP is a technically demanding yet safe procedure that achieves oncologic and long-term functional outcomes comparable to primary prostatectomy. Prior HoLEP should not preclude curative surgical management of prostate cancer, provided the operation is performed by experienced surgeons in high-volume centers. Full article

Background/Objectives: Carbon-ion radiotherapy (CIRT) offers precise dose distribution and enhanced biological effectiveness in localized prostate cancer. However, the safety of CIRT in patients with a history of surgery for benign prostatic hyperplasia (BPH), such as transurethral resection of the prostate (TURP), remains unclear. This study aimed to evaluate the long-term safety and oncological outcomes of CIRT in this population. Methods: A retrospective analysis was conducted in 74 of 3848 patients with prostate cancer and a history of surgery for BPH who underwent CIRT combined with risk-adapted androgen deprivation therapy between 2007 and 2023. Adverse events were assessed using CTCAE v5.0. Biochemical recurrence-free survival was estimated using the Kaplan–Meier method and risk factors for hematuria with multivariate logistic regression and receiver operation characteristic (ROC) analysis. Results: CIRT was generally well-tolerated. Early Grade 2 genitourinary (GU) adverse events occurred in 5.4% of patients, and late-Grade 2 or higher GU events occurred in 8.1%. The cumulative incidence of Grade 2 ≥ GU events remained 10% at 36 months. Compared to holmium laser enucleation of the prostate, a shorter interval between BPH surgery and CIRT initiation and a history of TURP were independently associated with an increased risk of hematuria. Notably, 5-year bRFS was 100% in low- and intermediate-risk groups and 88.6% in the high-risk group. Conclusions: CIRT demonstrates acceptable oncological outcomes and urinary complication rates in patients with prostate cancer and a history of BPH surgery. These findings suggest that CIRT can be a feasible treatment option in this surgically altered population, but careful patient selection, individualized treatment planning, and long-term follow-up are essential. Given the absence of a non-BPH control group, oncological efficacy should be interpreted with caution. Full article

Background/Objectives: The aim of this research was to compare perioperative outcomes, functional results, quality of life, and complications between robot-assisted simple prostatectomy (RASP) and holmium laser prostate enucleation (HoLEP) as minimally invasive techniques for treating benign prostatic hyperplasia (BPH) in large prostates (>150 cm³). Methods: This retrospective, multicenter, observational study (2007–2023) included patients with >150 cm³ prostate volumes who underwent either HoLEP or robot-assisted prostatectomy. Primary outcomes: success rate (complete enucleation, without transfusion or reintervention), good postoperative quality of life (IPSS 8th question score: 0–2), and continence at 6 months (no pads). Secondary outcomes: operative and catheterization time, hospital stay, enucleated gland weight, PSA reduction, Qmax improvement, and perioperative complications. Results: We included 95 HoLEP and 50 RASP patients with similar demographics and prostate volume (HoLEP: 187.72 cm³; RASP: 203.38 cm³). The success rate (HOLEP: 83.2%; RASP: 74%), continence rate (HoLEP: 85.1%; RASP: 86%), and quality of life (HoLEP: 83.2%; RASP 94%) were similar (p = 0.275, p = 1, and p = 0.075, respectively). HoLEP had a shorter operative time (97.58 vs. 122.4 min) and catheterization duration, with similar hospitalization duration (HoLEP: 3.46 days; RASP: 4.22 days). Although there was no significant difference in enucleated gland weight, HoLEP was more efficient (1.28 g/min vs. 1.06 g/min). Complication rates were similar (HOLEP: 15.5%; RASP: 26%; p = 0.12). Conclusions: Both RASP and HoLEP are safe for treating BPH in prostates >150 cm³, reporting similar success and continence rates and good quality of life after surgery. However, HoLEP achieved results with shorter operative time and catheterization duration. Full article