Assessing the Durability of Selective Median Lobe Holmium Laser Enucleation of the Prostate: A Retrospective Cohort Study.

Holmium laser enucleation of the prostate (HoLEP) is as an effective, size-independent treatment for benign prostatic hyperplasia (BPH) with durable outcomes. However, one of its adverse outcomes is post-operative stress urinary incontinence (SUI). We sought to determine if membranous urethral length (MUL) as measured on preoperative magnetic resonance imaging is a predictor for post-operative SUI in patients undergoing HoLEP for BPH. A single-center, retrospective observational study was conducted on 147 consecutive patients who underwent HoLEP for BPH between 2018 and 2024. Preoperative baseline characteristics, perioperative details, and SUI outcomes at 1, 3, and 6 months were collected. Binary logistic regression was used to assess the association between MUL and SUI at each follow-up interval. Median MUL was 8.2mm (IQR 6.1-11.0), and post-operative SUI incidences were 73 (49.7%), 36 (24.5%), and 16 (10.9%) at 1, 3, and 6 months respectively. Longer MUL was significantly associated with lower odds of SUI at 1 month (OR: 0.86, 95% CI: 0.77-0.96, p = 0.009), 3 months (OR: 0.77, 95% CI: 0.65-0.91, p = 0.002), and 6 months (OR: 0.65, 95% CI: 0.49-0.87, p = 0.004). Internal validation demonstrated good discrimination (areas under the curve of 0.73, 0.75, and 0.83 at 1, 3, and 6 months) with well-calibrated models, and decision curve analysis confirmed clinical utility within prespecified risk thresholds. Longer MUL is significantly associated with lower rates of SUI following HoLEP at 1, 3, and 6 months. Longer MUL may serve as a valuable predictive factor for continence recovery and should be considered during preoperative counseling and surgical decision planning.

Urethral stricture is a common urological disease characterized by a narrowing of the urethra leading to functional changes that reduce or completely block urine flow from the kidney to the bladder. This condition significantly affects the patient's quality of life and can lead to serious complications, such as urethral dilatation and hydronephrosis, which may result in irreversible kidney failure if left untreated. This was an observational cross-sectional study conducted on 35 patients, treated for urethral stricture at the Department of Uro-nephrology Surgery, Ninh Thuan Province General Hospital, from January to October 2023. All enrolled patients underwent urethral stricture endoscopic incision using holmium laser, and were followed up at 1 and 3 months postoperatively. The difference in the degree of hydronephrosis on CT scans before and after surgery at 3 months was statistically significant (p < 0.01). To report the safety and efficacy outcomes of holmium laser urethrotomy for the treatment of urethral stricture, patients underwent internal urethrotomy with holmium laser energy, with an average age of 47.7 ± 15.8 years (range: 15-72 years). Thirty patients (85.7%) underwent urological surgery, 3 (8.6%) underwent obstetric and gynecological surgery, and 2 (5.7%) had unknown etiologic causes. The use of the holmium laser for the management of urethral strictures has been found to be safe and effective, ensuring shorter operating times, a lower recurrence rate, and fewer serious postoperative complications.

This study aimed to compare the clinical safety, surgical efficacy, and oncologic outcomes of three transurethral resection techniques: the conventional monopolar transurethral resection of bladder tumor (CM-TURBT), the bipolar transurethral resection of bladder tumor (BP-TURBT), and the holmium laser en bloc resection of bladder tumor (HoL-ERBT) in patients with primary non-muscle-invasive bladder cancer (NMIBC). This retrospective single-center cohort study included consecutive patients with primary NMIBC treated between January 2020 and March 2025. All eligible patients undergoing CM-TURBT, BP-TURBT, or HoL-ERBT were analyzed. To minimize confounding related to non-random treatment allocation, the inverse probability of treatment weighting (IPTW) based on propensity scores was applied. Perioperative outcomes, complication rates, detrusor muscle inclusion, visible complete resection, and recurrence-free survival (RFS) were compared using weighted analyses. Time-to-event outcomes were assessed with IPTW-adjusted Kaplan-Meier curves and Cox regression models. After IPTW adjustment, HoL-ERBT was associated with significantly shorter resection times, lower hematuria rates, and reduced catheterization and hospitalization durations compared with CM-TURBT (p < 0.001 for all), while BP-TURBT demonstrated intermediate outcomes. Detrusor muscle inclusion was highest with HoL-ERBT (approximately 93%), compared with CM-TURBT (≈ 66%) and BP-TURBT (≈ 77%). IPTW-adjusted RFS at 12, 24, and 36months did not differ significantly among the techniques. HoL-ERBT provides meaningful perioperative and pathological advantages over conventional TURBT techniques in NMIBC without compromising short- to mid-term oncologic outcomes. To our knowledge, this is the first study with a follow-up period exceeding 24months. Despite procedural advantages, similar recurrence outcomes suggest that further prospective randomized trials are warranted to clarify the long-term oncologic role of HoL-ERBT.

To explore the best endoscopic management for men with benign prostatic hyperplasia (BPH) and an enlarged median lobe. A systematic search was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, Embase, Web of Science, and CENTRAL from 2010 to February 2025. Eligible studies included patients with BPH and an enlarged median lobe treated endoscopically. Perioperative data and patients' outcomes were summarized descriptively. From the 613 initially identified studies, 17 were included. Procedures evaluated included holmium laser enucleation of the prostate (HoLEP, n = 6), Rezūm (n = 4), GreenLight photovaporization (n = 2), Aquablation (n = 2), UroLift (n = 2) and transurethral resection of the prostate (TURP, n = 1). Studies either selectively treated the median lobe (ML-HoLEP and ML-TURP) or targeted the entire gland, including the median lobe (PVP, Aquablation, Rezūm, UroLift). Overall, all modalities provided significant improvements in urinary symptoms in patients with an enlarged median lobe. ML-HoLEP and ML-TURP demonstrated ejaculatory and continence outcomes comparable to minimally invasive approaches. Postoperative outcomes were reported inconsistently: only four studies provided a complete set of functional and sexual outcomes, and definitions of "median lobe" varied widely. Optilume or iTind procedures consistently excluded patients with significant median lobes. Heterogeneous definitions and incomplete reporting prevented quantitative analysis and definitive comparisons across modalities for this BPH sub-group. The procedures reviewed demonstrated favorable functional outcomes for men with an enlarged median lobe and can therefore be considered, while Optilume and iTIND should not be offered. Patients must be counselled about procedure-specific adverse events and the likelihood of surgical or medical retreatment. To guide future research and clinical practice, we present an expert guidance recommending standardized median-lobe definitions and a minimum outcome set.

To assess the surgical safety, efficacy and quality of life in patients suffering from stress urinary incontinence after desobstructive surgery for benign prostatic enlargement, we analyzed data from patients treated with the Adjustable Transobturator Male System (ATOMS) at our tertiary referral center. We retrospectively analyzed 27 patients with stress urinary incontinence (SUI) after desobstructive surgery (transurethral resection of the prostate (TUR-P): n = 17; Holmium laser enucleation of the prostate (HoLEP): n = 10) who underwent ATOMS implantation at our high-volume incontinence-surgery center between 2018 and 2024. Patients with prior prostatectomy or cancer-related surgery were excluded. Pre- and postoperative continence parameters, complications, and patient-reported outcomes were assessed using questionnaires, 24-h pad tests, and standardized instruments. The median follow-up was 32 months. Baseline demographics were comparable across groups. HoLEP patients had a significantly higher resected tissue weight (95.0 g vs. 26.0 g, p = 0.008) and required greater cushion volume (8.0 ml vs. 7.0 ml, p = 0.035). Complete continence rates were 64.7% (TUR-P) and 80.0% (HoLEP, p = 0.401). Postoperative pad test results (12.0 ml vs. 11.0 ml), complication rates, and satisfaction levels showed no significant differences. Explantation occurred in ~10% of patients, with high patient-reported satisfaction and willingness to recommend the implant across both groups. ATOMS implantation is a feasible, safe, and effective treatment for SUI following both TUR-P and HoLEP. Importantly, neither the type of prior surgery nor the volume of resected prostate tissue negatively impacted outcomes. These findings support the broader application of ATOMS in patients with post-BPE SUI, including those with large prostate volumes.

ABSTRACT Background Digital health literacy (e-HL) is an increasingly popular analysis of patients' awareness of appropriate treatment modalities. This study aimed to evaluate e-HL levels in men undergoing Holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and its potential impact on their quality of life. Methods A total of 106 patients scheduled for HoLEP were included. Age, body mass index (BMI), prostate-specific antigen (PSA), prostate volume, preoperative uroflowmetry values, e-HL scores, International Standard Classification of Education (ISCED) levels, and internet usage data were recorded. The EuroQoL Quality of Life (EQ-5D-5L) questionnaire was administered at three months postoperatively. Follow-up uroflowmetry results, IPSS scores, and quality of life (QoL) assessments were compared with e-HL scores. A cutoff value for digital health literacy was identified. Results The mean age was 68 years, BMI 29.1 kg/m², prostate volume 86.6 cc, and PSA 7.5 ± 4.6 ng/ml. The mean e-HL score was 16.8 ± 9.8, which was negatively correlated with age and BMI, positively with ISCED level and internet use (p < 0.001). The cutoff for adequate e-HL was 18.5. No significant correlation was found between e-HL and postoperative IPSS, EQ-5D-5L scores. Conclusion e-HL levels in HoLEP patients were not associated with symptom severity, postoperative outcomes, or quality of life. Further multicenter studies are needed.

Prospective, non-randomized, controlled investigation of prostate (P) artery embolization (E) compared to holmium (Ho) laser enucleation of prostate for the treatment of symptomatic benign prostatic hyperplasia with prostate volume 80–250 cc: the hope trial outcome at 1 year

Can a Subdural Hematoma Develop After Spinal Anesthesia Even if Warfarin is Stopped at the Appropriate Time? A Case Report.

Holmium Laser Enucleation of the Prostate in Octogenarians: 16-year Experience in a High-volume Center.

Renal rupture following percutaneous nephroscopic holmium laser lithotripsy: A case report

ObjectiveTo review recent trends in common functional urology surgery in England, using the Hospital Episode Statistics (HES) database.Patients and methodsData between 2013 and 2024 were obtained from the HES database, a publicly available dataset recording details about procedures in NHS England. We recorded the procedures for treatment of female stress urinary incontinence (SUI), urgency urinary incontinence (UUI), post-prostatectomy incontinence (PPI), vesicovaginal fistula (VVF) and benign prostatic enlargement (BPE) surgery.ResultsEarly in the study period, the most common procedures for SUI were insertion of transobturator and tension-free vaginal tape (8319 procedures/year). We observe an almost complete halt in tape insertion and an increase in removal from 2019 (8 procedures/year), due to concerns about complications and the ‘mesh pause’ in the UK. Injection of bulking agents became the mainstream treatment from 2019 (2490 procedures/year). For refractory UUI, intravesical Botulinum toxin A (BTX) remains the preferred treatment modality (9842 procedures/year). No significant increases in neuromodulation were observed (762/year), and numbers remain low for ileocystoplasty (100/year). Transurethral Resection of the Prostate (TURP) remains the commonest operation for BPE with 15,579 cases in 2023–2024. Laser resection modalities (Holmium laser Enucleation, or HoLEP, and Photoselective Vaporization of the Prostate, or PVP) saw increases with 5098 cases in 2023–2024. VVF repair numbers remain low, averaging 83 per year. There was a reduction in overall surgical numbers during the COVID-19 pandemic, with a partial recovery from 2022 onwards.ConclusionDue to concerns around tape-related complications, bulking agents are now the mainstream treatment of SUI in women, and BTX in UUI. Whilst the use of laser is becoming increasingly popular, TURP remains the commonest procedure performed for BPE. There has only been a partial recovery in surgical numbers following the pandemic.

High-power holmium laser versus pulsed thulium laser for ureteroscopic lithotripsy: Results of a randomized prospective study

Assessing the Durability of Selective Median Lobe Holmium Laser Enucleation of the Prostate: A Retrospective Cohort Study.

Holmium laser enucleation of the prostate versus transurethral resection of the prostate for benign prostatic hyperplasia: evidence from a Korean retrospective analysis using the Common Data Model

Recently, surgical treatment methods for benign prostatic hyperplasia (BPH) have been constantly being modernized. New minimally invasive techniques aim to be as effective as standard resection but safer. Laser methods are combined with advanced prostate enucleation techniques, such as the successful introduction of holmium laser enucleation of the prostate (HoLEP). The objective: to analyze the features of the performance, productivity and effectiveness of the intervention, intraoperative and postoperative complications, immediate and long-term results of bipolar transurethral enucleation of the prostate (B-TUEP) in patients with benign prostatic hyperplasia of large size. Materials and methods. Surgical intervention was performed in 65 patients aged 59 to 80 years. In addition to standard clinical and laboratory tests, patients underwent transrectal ultrasound and uroflowmetry examination. For the statistical determination of quantitative indicators, the mean and standard deviation (in the form of M ± σ) were used, for ordinal and nominal variables, frequencies and percentages were given. Results. Intraoperative complications were observed in 6 (9.2%) patients. Of these, 3 (4.6%) had perforation of the prostate capsule along the posterior wall with the formation of a cavity under the bladder, and 3 (4.6%) had extravasation of irrigation fluid. Early postoperative complications occurred in 7 (10.8%) cases in 6 (9.2%) patients and were represented by bleeding in 2 (3.1%) cases, orchiepididymitis in 3 (4.6%) cases, and early imperative urinary incontinence in 2 (3.1%) cases. Before the operation, the average value of the IPSS (International Prostate Symptom Score) index was 32.1 ± 1.3 points. During the subsequent follow-up, an involution of infravesical obstruction symptoms was noted, and a decrease in the IPSS index was noted during the patient interview. At 1 month after B-TUEP, the mean value of the IPSS index was 11.4 ± 1.1 points (p &lt; 0.05), and at 6 months – 10.7 ± 0.9 points (p &lt; 0.05). Conclusions. Analyzing the results of surgical removal of large BPH (150–320 cm3) using bipolar transurethral enucleation, it was determined that: 1) intraoperative, early and late complications are rare and not critical; 2) with the weight of the removed prostate tissue up to 250 g, the operation time ranged from 60 to 80 minutes. If the mass was more than 250 g, the duration of the operation increased to 100–158 minutes, which was obviously due to the technical features of the surgical intervention: difficulties in enucleating a large mass of prostate tissue, as well as an increase in the time of morcellation of the removed adenomatous nodes; 3) positive dynamics and normalization of functional, clinical and laboratory parameters, as well as the patient’s quality of life are noted within 1 month after surgery; 4) the duration of the early postoperative period and postoperative therapy is usually 2–5 days and does not exceed 1 week. Thus, B-TUEP surgery with a large volume of hyperplastic tissue (in our observations, more than 150 cm3) is an effective and safe method of surgical treatment.

Introduction: Holmium laser enucleation of the prostate (HoLEP), multi-port robotic simple prostatectomy (MP-RASP), and single-port robotic simple prostatectomy (SP-RASP) are three widely accepted treatment options for benign prostatic hyperplasia. We present the first study to directly compare all three modalities. Methods: Patients undergoing HoLEP, MP-RASP, or SP-RASP between 2022 and 2024 were retrospectively analyzed. Various preoperative, perioperative, and postoperative variables and outcomes were assessed. Results: A total of 92 HoLEP, 42 MP-RASP, and 59 SP-RASP patients were analyzed. The mean prostate size was larger for MP-RASP compared to HoLEP and SP-RASP (p < 0.001). Mean operative times were lower for HoLEP compared to MP-RASP and SP-RASP (p < 0.001). Estimated blood loss (EBL) was significantly different between all three cohorts (p < 0.001). Transfusion rates were no different (p = 0.2). The mean prostate tissue removed during the surgical procedure was significantly higher for MP-RASP vs HoLEP (p < 0.001) and MP-RASP vs SP-RASP (p < 0.001) but not for SP-RASP vs HoLEP (p = 0.22). Mean catheter duration was significantly higher for MP-RASP compared to HoLEP and SP-RASP (p < 0.001). 31% of MP-RASP and 63% of SP-RASP patients were discharged the same day compared to 8% of HoLEP. The transient incontinence rates were 30% for HoLEP vs 17% for MP-RASP vs 8% for SP-RASP (p = 0.004). Conclusion: HoLEP had a decreased operative time, shorter catheter duration, and increased incontinence rates, whereas both MP-RASP and SP-RASP had a greater amount and percentage of prostatic tissue removed. MP-RASP removed a greater amount of tissue and had a longer catheter duration compared to SP-RASP.

Background: Holmium laser enucleation of the prostate (HOLEP) surgery has played a significant role in the treatment of benign prostatic hyperplasia. Since the definition of the classical three-lobe technique, many new techniques have been introduced. We aimed to compare the efficacy and safety of the en bloc and three-lobe techniques used in this surgery. Material and Methods: Medical data of 80 patients who underwent HoLEP surgery at a tertiary center were evaluated retrospectively. The patients were divided into 2 groups (en-bloc: 40, three-lobe: 40). All patients were evaluated for age, preoperative PSA, prostate size, maximum flow rate (Qmax), enucleation time, morcellation time, enucleated tissue weight, enucleation time efficacy (enucleated weight/enucleation time), morcellation time efficacy (enucleated weight/morcellation time), perioperative and postoperative complications and incontinence status. Results: There was no significant difference between the two groups in terms of age, PSA, and preoperative uroflowmetry results. 8 patients in the en-bloc group and 11 patients in the three-lobe group had a catheter preoperatively. Enucleation time was significantly shorter in the en-bloc group (p&amp;lt;0.001), while morcellation time was similar (p=0.706). Although the prostate volume was higher in the three-lobe group (p=0.013), no difference was observed in terms of enucleated tissue weight (p=0.261). Postoperative uroflowmetry results were similar in the two groups (p=0.628). Postoperative hematuria was observed in 2 patients in the en-bloc group and 4 patients in the three-lobe group. Prolonged incontinence developed in 6 patients in the en-bloc group and in 7 patients in the three-lobe group. No statistically significant difference was observed between the two groups in terms of complications. Conclusion: In reviewing the results of our study, we observed that both techniques yield comparably satisfactory outcomes and similar rates of late complications. However, the en-bloc technique demonstrates a significantly shorter enucleation time as well as a reduced overall operative duration.

Purpose: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating kidney stones >20 mm because of its superior stone-free rates (SFR). However, high-power holmium lasers may challenge this standard. This study evaluates the feasibility, safety, and efficacy of high-power holmium laser retrograde intrarenal surgery (RIRS) for the treatment of kidney stones >20 mm. Methods: We conducted a retrospective analysis of patients with kidney stones >20 mm treated with either 80W- or 120 W holmium laser RIRS between January 2020 and August 2024. Clinical, intraoperative, and postoperative data were collected. Outcomes included SFR, operative time, complications, and hospital stay. Comparisons between the older-generation (80 W) and newer-generation (120 W) systems were performed using the Mann-Whitney U test and chi-square test, and multivariable analyses identified predictors of non-stone-free status. Results: A total of 118 patients were included: 31 in the older-generation (80 W) group and 87 in the newer-generation (120 W) group. RIRS using the newer-generation 120 W laser was associated with a shorter operative time (66 vs 79 minutes, p < 0.001) and higher SFR at 5 weeks (82.7% vs 58.1%, p = 0.006), 6 months (92% vs 64.5%, p < 0.001), and 1 year (96.5% vs 83.8%, p = 0.016) postoperative evaluations. Complication rates did not differ significantly between groups (5.7% vs 3.2%, p = 0.208). In multivariable analysis, the use of older-generation 80 W laser was an independent predictor of non-stone-free status at both the first (OR 4.4, p = 0.004) and second (OR 8.8, p = 0.001) follow-up visits. Conclusions: Treatment of renal stones larger than 2 cm with the newer-generation 120 W Ho:YAG laser is effective, with higher SFR rate and shorter operative time, compared to the older-generation 80 W Ho:YAG laser.

Background and Objective: Benign prostatic hyperplasia (BPH) represents a common condition in aging males. For prostates exceeding 80 g, robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation have emerged as leading treatments. This study aimed to comprehensively compare outcomes between these approaches. Methods: We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials and cohort studies. Outcomes included changes in urinary flow rate, International Prostate Symptom Score (IPSS), complication rates, operative bleeding, operative time, hospitalization duration, and catheterization period. Robotic interventions were classified as single-port (SP) or multiport with transvesical (TV), transperitoneal, or transcapsular techniques. Enucleation methods included holmium laser (HoLEP), thulium laser, bipolar, and GreenLight laser vapo-enucleation. Key Findings and Limitations: We included data from 25 studies with 3924 patients. Network meta-analysis showed no significant difference in overall complication rates between RASP and enucleation techniques, though RASP had the highest surface under the cumulative ranking curve scores in the SP approaches, particularly the SPTV approach. Both RASP and enucleation approaches showed similar improvements in urinary flow rates. RASP approaches, particularly SPTV, had the highest decrease in IPSS, but the changes were not statistically significant. Despite longer operative times and Foley catheterization durations for RASP, blood loss was comparable to enucleation techniques. Conclusion and Clinical Implications: Our results suggest that robotic approaches have similar performance to HoLEP when managing large prostates. However, robotic approaches may have slight differences including improved symptom scores, lower incontinence rates, longer operative times, and longer hospital stays. Patient Summary: In this study, we compared two modern surgical approaches for treating enlarged prostates over 80 g-robotic surgery and laser/electrical techniques that remove prostate tissue through the urethra. We found both approaches work equally well for improving urinary flow, with similar bleeding risks, though the robotic approach may better reduce urinary symptoms but requires longer surgery and hospital stays. This information helps doctors and patients choose the most suitable treatment option for large prostate enlargement.