Holmium Laser Enucleation of the Prostate Vs. Bipolar Transurethral Resection of the Prostate for Small-Volume Prostates: A Comparative Analysis of Clinical Outcomes

Abstract

Objective: Benign prostatic hyperplasia is a common cause of lower urinary tract symptoms (LUTS) in aging men. While transurethral resection of the prostate (TURP) is the traditional surgical standard, holmium laser enucleation of the prostate (HoLEP) has emerged as a safe and effective alternative. Evidence comparing both techniques in small prostates (<50 mL) remains limited.

Methods: This retrospective study included male patients aged 40-80 years who underwent bipolar TURP (B-TURP) or HoLEP between 2023 and 2025 for LUTS refractory to medical therapy, with prostate volume <50 mL. Pre- and postoperative parameters, including operative time, resected tissue weight, irrigation volume, hospital stay, catheterization time, and functional scores (International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), peak urinary flow rate (Qmax), postvoid residual urine (PVR)) were compared.

Results: No significant differences were found between groups regarding age, body mass index, comorbidities, prostate-specific antigen, prostate volume, ICIQ-SF scores, IIEF-5, complication rates, or postoperative hemoglobin decrease (all P > .05). Holmium laser enucleation of the prostate showed longer operative time, greater irrigation use, and higher resected tissue weight/percentage (P = .03, .02, <.001, <.001), while hospital stay and catheterization were shorter (both P < .001). Both procedures improved Qmax and IPSS and reduced PVR (all P < .001); the increase in Qmax was greater in HoLEP (P = .025).

Conclusion: Both B-TURP and HoLEP are safe and effective for small prostates; however, HoLEP offers advantages in resected tissue weight, Qmax improvement, and shorter hospital stay/catheterization.

Cite this article as: G.lbaşı A, Elmaağa. B, Bi.er H, .zercan AY, Günal S, Keske M. Holmium laser enucleation of the prostate vs. bipolar transurethral resection of the prostate for small-volume prostates: A comparative analysis of clinical outcomes. Urol Res Pract. 2025;51(6):225-229.