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

## TL;DR

This study shows that HoLEP surgery improves urinary symptoms and quality of life for men with enlarged prostates, regardless of prostate size, though larger prostates require longer procedures.

## Contribution

The study provides a multicenter comparative analysis of HoLEP outcomes based on prostate volume in Jordan.

## Key findings

- HoLEP significantly improved urinary symptoms and quality of life in both small and large prostate groups.
- Larger prostates required longer enucleation times and more tissue removal.
- Functional outcomes like urinary flow rate improved similarly in both groups.

## Abstract

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.

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.

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.

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).

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.