# Efficacy and safety of low-power holmium laser enucleation of the prostate: experience gained from more than 700 cases

## TL;DR

This study shows that low-power holmium laser surgery for enlarged prostates is safe and effective, with results similar to higher-power techniques.

## Contribution

Demonstrates the safety and efficacy of low-power HoLEP through a large case series, offering a viable alternative to high-power methods.

## Key findings

- Significant improvements in urinary flow and symptom scores were observed within one month post-surgery.
- Low complication rates, including a 3.2% transfusion rate and 1.5% stress urinary incontinence, were reported.
- Outcomes were comparable to high-power HoLEP techniques, suggesting low-power settings are equally effective.

## Abstract

The aim of this study was to investigate the functional outcomes, safety, and effectiveness of low-power (LP) holmium laser enucleation of the prostate (HoLEP) using a 37.5 W holmium laser source.

We retrospectively reviewed 713 patients with a diagnosis of benign prostatic hyperplasia (BPH) treated with HoLEP using an LP setting (37.5 W laser set to 1.5 J with a frequency of 25 Hz). All procedures were performed by experienced urologists. Functional outcomes, perioperative parameters, and complications were assessed over a 12-month follow-up period. Effect sizes (Cohen’s d) and 95% confidence intervals (CI) were calculated to evaluate the magnitude and precision of changes in maximum urinary flow rate (Qmax), postvoiding residual volume (PVR), international prostate symptoms score (I-PSS), and other parameters.

The mean (SD) preoperative serum PSA level was 4.8 ng/mL (3.6), and the mean prostate volume was 94.02 mL (55.35). The average enucleation time was 72.42 min (32.36), morcellation time was 10.35 min (8.62), and total operation time was 82.74 min (38.08). At 1 month after the surgery, significant improvements were observed in I-PSS (from 25.01 (7.62) to 11.02 (5.3), Cohen’s d = 2.08, 95% CI 1.91–2.25), Qmax (from 10.7 (4.28) to 18.68 (9.52) mL/s, d = 1.08, 95% CI 0.93–1.22), and PVR (from 139.38 (18.07) to 24.85 (18.07) mL, d = 3.13, 95% CI 2.87–3.39), all with p < 0.001. Transfusion was required in 23 patients (3.2%) and early reoperation in 14 patients (2%). Stress urinary incontinence occurred in 11 patients (1.5%) during late follow-up but was resolved in all cases by the 6th month. These outcomes support the safety and efficacy of LP HoLEP, yielding results comparable to those reported with high-power (HP) laser techniques in the literature.

In this retrospective study, we showed that LP HoLEP can be performed safely and effectively, similar to other enucleation methods; however, further studies are necessary to validate its acceptance as a viable alternative to HP HoLEP.