Comparison of Outcomes after Holmium Laser Enucleation of the Prostate and Transurethral Resection of the Prostate

Rupam Deori 1 * , Renu Thomas 1, Nithya Rajan 1, Sudin Somarajan 1, Mayank Bharti 1, Vinyas Bairana Ananthamurthy 1
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1 Department of Urology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 5, pp. 38-43. https://doi.org/10.23950/jcmk/17151
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Author Contributions: Conceptualization, R.D. and  R.T.; methodology , R.D. and R.T.; validation – not applicable;  formal analysis – not applicable; investigation, R.T. ; resources – not applicable;  data curation, R.D. and N.R.; writing – original draft preparation, R.D.; writing – review and editing, R.D., S.S., M.B. and V.B.; visualization – not applicable; supervision – R.T., N.R.; project administration, S.S., M.B. and V.B.; funding acquisition – not applicable. All authors have read and agreed to the published version of the manuscript.

ABSTRACT

Introduction: Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. Holmium laser enucleation of the prostate (HoLEP), is considered a strong competitor to Transurethral resection of the prostate (TURP).
Objective: To determine the differences in short-term and medium-term outcomes of TURP and HoLEP in treatment of bladder outlet obstruction caused by BPH

Material and methods: This was a prospective observational study, carried out on BPH patients who underwent HoLEP or Monopolar TURP from April 2023 to September 2024. A total of 72 patients with prostate volume of less than 100 cc were assigned to two groups. Group A (n = 36) underwent surgical treatment with HoLEP, while Group B (n = 36) underwent monopolar TURP. All the procedures were performed by a single surgeon.

Results: Patients in the HoLEP group experienced shorter catheterization times and hospital stays than those in the TURP group, with both differences being statistically significant (P < 0.001). Additionally, the operating time differed significantly between the two groups, with HoLEP averaging 87.53 ± 15.93 minutes and TURP averaging 67.47 ± 9.98 minutes (P < 0.001). The mean hemoglobin loss was also lower in the HoLEP group (0.76 ± 0.36 g/dL) compared to the TURP group (1.57 ± 0.69 g/dL). At follow-up, both groups showed significant improvements from baseline in AUA symptom scores, Qmax, and PVR urine volumes

Conclusion: HoLEP offers less perioperative morbidity and similar efficacy at three months. Postoperative complications and improvements in symptoms, after HoLEP are comparable to those seen after TURP.
Keywords: Benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP), Transurethral resection of the prostate (TURP), maximum urinary flow rate (Qmax), post-void residual (PVR).

CITATION

Deori R, Thomas R, Rajan N, Somarajan S, Bharti M, Ananthamurthy VB. Comparison of Outcomes after Holmium Laser Enucleation of the Prostate and Transurethral Resection of the Prostate. J CLIN MED KAZ. 2025;22(5):38-43. https://doi.org/10.23950/jcmk/17151

REFERENCES

  • Roehrborn CG. The utility of serum prostatic-specific antigen in the management of men with benign prostatic hyperplasia. Int J Impot Res. 2008 Dec;20 Suppl 3:S19-26. doi: 10.1038/ijir.2008.53. PMID: 19002120.
  • Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989 Feb;141(2):243-7. doi: 10.1016/s0022-5347(17)40731-2. PMID: 2643719.
  • Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology. 1996 Jan;47(1):48-51. doi: 10.1016/s0090-4295(99)80381-1. PMID: 8560662.
  • Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004 Nov;172(5 Pt 1):1926-9. doi: 10.1097/01.ju.0000140501.68841.a1. PMID: 15540757.
  • Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year followup. J Urol. 1999 Nov;162(5):1640-4. PMID: 10524887.
  • Hamouda A, Morsi G, Habib E, Hamouda H, Emam AB, Etafy M. A comparative study between holmium laser enucleation of the prostate and transurethral resection of the prostate: 12-month follow-up. Journal of Clinical Urology. 2013;7(2):99-104. doi:10.1177/2051415813512302
  • Jhanwar A, Sinha RJ, Bansal A, Prakash G, Singh K, Singh V. Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: A prospective randomized study. Urol Ann. 2017 Jan-Mar;9(1):45-50. doi: 10.4103/0974-7796.198904. PMID: 28216929; PMCID: PMC5308038.
  • Eltabey MA, Sherif H, Hussein AA. Holmium laser enucleation versus transurethral resection of the prostate. Can J Urol. 2010 Dec;17(6):5447-52. PMID: 21172109.
  • Aho TF, Gilling PJ, Kennett KM, Westenberg AM, Fraundorfer MR, Frampton CM. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial. J Urol. 2005 Jul;174(1):210-4. doi: 10.1097/01.ju.0000161610.68204.ee. PMID: 15947629.
  • Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int. 2006 Jan;97(1):85-9. doi: 10.1111/j.1464-410X.2006.05862.x. PMID: 16336334.
  • Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol. 2006 Sep;50(3):569-73. doi: 10.1016/j.eururo.2006.04.002. Epub 2006 May 2. PMID: 16704894.
  • Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003 Oct;170(4 Pt 1):1270-4. doi: 10.1097/01.ju.0000086948.55973.00. PMID: 14501739.
  • Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year followup. J Urol. 1999 Nov;162(5):1640-4. PMID: 10524887.
  • Kanchi V BR, Galeti EH, Begum S G. A comparative study between HoLEP and bipolar TURP in the treatment of benign prostatic hyperplasia. Journal of Clinical Medicine of Kazakhstan. 2023 Apr 21;20(2):15-19. Available at: https://doi.org/10.23950/jcmk/13129.
  • Kim SC, Matlaga BR, Kuo RL, Watkins SL, Kennett KM, Gilling PJ, Lingeman JE. Holmium laser enucleation of the prostate: a comparison of efficiency measures at two institutions. J Endourol. 2005 Jun;19(5):555-8. doi: 10.1089/end.2005.19.555. PMID: 15989444.