Benefits of holmium laser enucleation of the prostate (HOLEP) over transurethral resection (TURP) for bladder outlet obstruction (BOO) in patients with prostate cancer: a propensity score-matched evaluation for optimum palliative care

Demographic shift in industrial societies leads to increasing numbers of patients presenting with BOO due to locally advanced prostate cancer. As there is currently no guidelines recommendation on technique, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. Retrospective, propensity score-matched analysis of 1,373 and 2,705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes. Postoperative symptoms and urodynamic parameters improved irrespective of technique. With significantly increased resection and enucleation times for palliative indication, the benefits of HoLEP remain unchallenged by TURP. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While laser enucleation of the prostate is a safe and effective procedure, pHoLEP offers better surgical performance outcomes compared to pTURP. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.