# Prospective, non-randomized, controlled investigation of prostate (P) artery embolization (E) compared to holmium (Ho) laser enucleation of prostate for the treatment of symptomatic benign prostatic hyperplasia with prostate volume 80–250 cc: the hope trial outcome at 1 year

## TL;DR

This study compares two treatments for enlarged prostate, finding similar symptom improvement but different advantages in sexual function and hospital stay.

## Contribution

A direct comparison of PAE and HoLEP in men with large prostate sizes, focusing on functional outcomes and complications over one year.

## Key findings

- PAE showed better sexual function and urinary incontinence outcomes at 1 and 3 months compared to HoLEP.
- HoLEP outperformed PAE in PSA reduction, urine flow, and residual urine improvement at 3 and 12 months.
- PAE avoided catheterization and had shorter hospital stays, with no major adverse events in either group.

## Abstract

To compare outcomes of Prostate Artery Embolization (PAE) with Holmium Laser Enucleation of Prostate (HoLEP) for management of symptomatic benign prostate hyperplasia in men with prostate volume 80 to 250 cc.

In this open-label prospective clinical-trial, 45 patients were enrolled in a 2:1 ratio to undergo PAE and HoLEP, respectively. The voiding parameter, sexual function, and complications were evaluated at 1, 3, 6, and 12-months. The primary endpoint was a reduction in the International Prostate Symptom Score (IPSS) at 3 months. Secondary-outcomes were change in the International Index of Erectile Function-15 (IIEF-15), International Consultation on Incontinence Questionnaire-urinary incontinence (ICIQ-UI), Quality-of-Life (QoL), IPSS, uroflow (Qmax) and Prostate Specific Antigen (PSA). Adverse-events were recorded and graded using the Clavien–Dindo Adverse-event (CD-AE) classification.

No significant difference in median IPSS and quality of life improvement was observed at any follow-up point. PAE had significantly better IIEF-15 and ICIQ-UI outcomes than HoLEP at 1 and 3 months. HoLEP outperformed PAE in PSA reduction, Qmax, and post-void residual (PVR) improvement at 3 and 12-months. However, PAE had shorter hospital stays and avoided catheterization. No major adverse events (Clavien–Dindo ≥ grade 3) occurred in either group.

In men with BPH and prostate sizes 80–250gm, PAE and HoLEP produce similar IPSS and QoL improvement at medium-term follow-up. PAE had better IIEF-15 and ICIQ-UI, in addition to the advantage of avoiding catheterization and reduced hospital stay. HoLEP performed better in PSA reduction, Qmax, and PVR improvement at 3 and 12 months. No serious adverse events occurred in either treatment group. Small sample size and short-term follow-up were important limitations.

The online version contains supplementary material available at 10.1007/s00345-025-06115-0.