Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) for Benign Prostatic Hyperplasia: A Meta-Analysis

Abstract

Introduction: Transurethral resection of the prostate (TURP) has long been the gold standard for surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation of the prostate (HoLEP) has emerged as a size-independent alternative that endoscopically mimics open prostatectomy. This review compares their long-term efficacy and safety.

Methods: We conducted a search of MEDLINE and CENTRAL for RCTs comparing HoLEP to monopolar or bipolar TURP for symptomatic BPH. Primary outcomes were improvements in International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and the long-term re-treatment rate for recurrent BPH.

Results: The meta-analysis of numerous RCTs showed that both HoLEP and TURP resulted in significant and comparable improvements in IPSS and Qmax. However, HoLEP was superior in its ability to treat very large glands, and it was associated with less perioperative bleeding and a shorter catheterization time. Crucially, the long-term re-treatment rate was significantly lower following HoLEP.

Discussion: HoLEP is a highly efficient and durable procedure for BPH. Its ability to completely remove the adenomatous tissue provides a lasting effect that surpasses TURP, reducing the need for future surgical interventions. The main limitation of HoLEP is its steep learning curve.

Conclusion: HoLEP is a superior alternative to TURP for BPH, offering equivalent functional outcomes with improved safety, applicability to all prostate sizes, and superior long-term durability.