Minimally Invasive Holmium Laser Enucleation of the Prostate (MiLEP) Vs. HoLEP: Retrospective Analysis of Perioperative Outcomes in a Propensity Score-Matched Cohort.

Background: Holmium laser enucleation of the prostate (HoLEP) is a well-established, size-independent surgical treatment offering favorable perioperative outcomes. Recently, minimal invasive laser enucleation of the prostate (MiLEP) has been introduced as a miniaturized approach utilizing a 22 Fr endoscope. However, comparative perioperative data on MiLEP versus HoLEP remain scarce.

Materials and methods: A retrospective propensity-matched (PSM) cohort analysis was conducted, comparing the perioperative outcomes of the first 100 MiLEPs performed at our center versus standard HoLEP. After the PSM of 2187 patients, data from 200 patients (HoLEP: n = 100, MiLEP: n = 100) treated at a high-volume laser center were analyzed. Key parameters included operative time, enucleated tissue volume, complication rates, and catheterization duration. Statistical significance was set at p < 0.05.

Results: Demographic characteristics, overall operative (36 vs. 35 min, p = 0.87), and enucleation times (22 vs. 23 min, p = 0.68) were comparable between MiLEP and HoLEP. However, MiLEP showed significantly shorter median morcellation times (5 vs. 3 min, p = 0.03), while coagulation time was longer (6 vs. 5 min, p = 0.02). Overall, complication rates were similar between both groups (15% vs. 16%, p = 0.85), with similar Clavien-Dindo distributions (Grade II: 13% vs. 11%; Grade IIIb: 2% in both groups). Recatheterization (8% vs. 4%, p = 0.23), macrohematuria requiring prolonged catheterization (1% vs. 5%, p = 0.1), and postoperative fever (4% vs. 5%, p = 0.73) showed no significant differences and were size-independent across prostates < 30, 30-59, and > 60 mL.

Conclusion: Implementation of MiLEP is safe and feasible in a center with HoLEP experience, demonstrating comparable perioperative outcomes. The miniaturized approach maintains surgical efficiency across different prostate sizes while reducing instrument size. Further studies are necessary to evaluate long-term functional outcomes and confirm the potential benefits of MiLEP regarding urethral trauma.