Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia

J Urol. 2004 Nov;172(5 Pt 1):1926-9. doi: 10.1097/01.ju.0000140501.68841.a1.


Purpose: To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia.

Materials and methods: From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup.

Results: At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected.

Conclusions: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Follow-Up Studies
  • Humans
  • Laser Therapy*
  • Male
  • Middle Aged
  • Prospective Studies
  • Prostatic Hyperplasia / complications*
  • Prostatic Hyperplasia / surgery*
  • Transurethral Resection of Prostate / methods*
  • Urethral Obstruction / etiology*
  • Urethral Obstruction / surgery*