Holmium laser enucleation of the prostate (HoLEP) is currently one of the most effective surgical techniques for treating urinary symptoms associated with benign prostatic hyperplasia (BPH), even in the most complex cases. However, the procedure is not entirely free of complications and requires that patients be properly informed. The surgeon’s experience is of fundamental importance in reducing perioperative and postoperative risks.
To investigate these issues further, our researchers analyzed the outcomes of 243 patients who underwent HoLEP performed by a surgeon with over 1,600 procedures to his credit, including clinical and laboratory follow-up and telephone interviews over a 12-month period. This was a clinically challenging patient population: approximately 60% had enlarged prostates (>80 mL), and over 30% were catheterized prior to surgery.
The functional outcomes were extremely positive. After just 3 months, 90% of patients were urinating at a flow rate exceeding 20 mL/s, while approximately 75% no longer had any post-void residual urine. Furthermore, urinary symptoms improved significantly as early as the first month and continued to improve for up to one year after the procedure.
An important aspect concerns the recovery of urinary continence, which occurs gradually over time. At 1 month, approximately 68% of patients have regained complete continence; this percentage rises to 83% at 3 months and reaches 95% at 12 months. This means that a significant proportion of patients may experience urinary leakage in the first few weeks after surgery, but in most cases this is a temporary condition that will improve on its own.
Sexual function also tends to recover over time: approximately 53% of patients regain erectile function as early as 1 month post-surgery, a percentage that rises to 85% at 12 months. However, it is important to inform patients that retrograde ejaculation occurs in nearly all cases, representing an expected side effect of the procedure. Nevertheless, erectile function was maintained in the postoperative period in the majority of sexually active patients. It is important to note that a significant proportion of patients reported an increase in their IIEF-EF score, confirming previous observations: an improvement in erectile function associated with a reduction in urinary symptoms following surgery for benign prostatic hyperplasia.
Overall, these results confirm that HoLEP is a highly effective and safe procedure, even in complex patients when treated at highly specialized centers.
Capogrosso P, Ventimiglia E, Fallara G, Schifano N, Costa A, Candela L, et al. Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even When Performed by an Experienced Surgeon After the Learning Curve Has Been Completed. Eur Urol Focus. 2023.
