# Holmium laser enucleation of prostate via perineal urethrostomy for the treatment of benign prostatic hyperplasia with mild long segment stenosis of the anterior urethra

## TL;DR

This study shows that a specific laser surgery can safely treat prostate enlargement with mild urethral narrowing, improving urinary symptoms.

## Contribution

HoLEP via perineal urethrostomy is proposed as a novel surgical approach for BPH with anterior urethral stenosis.

## Key findings

- Operation time averaged 79.6 minutes with minimal blood loss and few complications.
- Patients showed significant improvement in urinary flow and symptom scores at 12 months.
- Only one case required additional treatment for perineal stoma stenosis.

## Abstract

To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) via perineal urethrostomy. This procedure is used for treating benign prostatic hyperplasia (BPH) with mild long segment stenosis of the anterior urethra.

The clinical data of 18 patients with BPH with mild long segment stenosis of the anterior urethra who underwent HoLEP via perineal urethrostomy from January 2023 to April 2024 were retrospectively analyzed. The patients’ baseline data, intraoperative conditions, and early postoperative complications were collected. The International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postoperative residual urine (PVR) were compared before the operation, and at 1, 6 and 12 months postoperatively.

The operation time of 18 patients was 79.6 ± 13.2 min. Hemoglobin decreased by 12.7 ± 4.0 g/dl from before to after surgery. The length of urethral stricture was 3.7 ± 0.6 cm, including 11 patients with penile urethral stricture and 7 patients with bulbar urethral stricture. 5 cases (27.8%) experienced transient urinary incontinence, which resolved within 3 months after surgery. 1 case (5.6%) experienced perineal stoma stenosis and was resolved after three urethral dilations. Moreover, compared with preoperative, all patients showed significant improvement in Qmax, IPSS, QOL and PVR at 1, 6, and 12 months after surgery (P < 0.05). At 12 months after surgery, all patients had unobstructed urination and did not require secondary urethroplasty.

HoLEP via perineal urethrostomy is a safe and effective alternative surgical option for treating BPH with mild long segment stenosis of the anterior urethra, which can overcome the limitations caused by urethral stricture and significantly improve patients’ lower urinary tract symptoms (LUTS). However, this procedure remains exploratory and remedial. Its effectiveness requires further validation through multicenter, large-sample studies with long-term follow-up.