Multicenter comparative analysis of preoperative and postoperative outcomes after holmium laser enucleation of the prostate based on the prostate volume.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is considered the best treatment for benign prostatic hyperplasia (BPH). This procedure offers effective symptom relief across varying prostate sizes.

Aim: This study aimed to evaluate preoperative and postoperative outcomes of HoLEP in patients with different prostate volumes in a multicenter comparative analysis conducted in Jordan.

Materials and methods: A cohort study was conducted in 3 private clinics in Amman, Jordan. It included 77 patients who were divided into 2 groups according to prostate volume: smaller than or equal to 40 ml (n = 37) and larger than 40 ml (n = 40). The data collected preoperatively and at 3 months postoperatively included urinary symptoms, quality of life (QoL) scores, and functional parameters. Statistical analyses included paired t tests and independent t tests.

Results: Both groups exhibited improvements in relation to initial values, as assessed after the procedure using the International Prostate Symptom Score (≤40 ml, 16 vs 7.6; >40 ml, 14.9 vs 4.6; P <⁠0.001). Their QoL scores also improved (≤40 ml, 3.2 vs 1.5; >40 ml, 3 vs 1.3; P <⁠0.001). The maximum urinary flow rate increased in both groups (≤40 ml, 8.2 ml/s vs 14 ml/s; >40 ml, 8.6 ml/s vs 13.6 ml/s; P <⁠0.001), with similar improvements in postvoid residual urine volume. Larger prostates required longer enucleation times (≤40 ml, 19.8 min; >40 ml, 39.3 min; P = 0.04) with more tissue removal (≤40 ml, 4.7 g; >40 ml, 17 g; P <⁠0.001).

Conclusions: HoLEP effectively improved various measured parameters, including urinary symptoms, QoL, and functional outcomes in patients with BPH across all prostate sizes. Larger prostates required procedures of increased complexity.