Transurethral anatomical enucleation of the prostate using a 1470-nm diode laser (DiLEP) versus transurethral resection of the prostate (TURP) for large-volume benign prostatic hyperplasia: a prospective randomized controlled trial

To evaluate the efficacy of transurethral anatomical enucleation using a 1470-nm diode laser (DiLEP) (1470 nm DiLEP) versus transurethral resection of the prostate (TURP) in improving lower urinary tract symptoms (LUTS) in patients with large-volume benign prostatic obstruction (BPO). In this prospective, open-label, randomized controlled trial, a total of 121 patients with large-volume BPO (> 90 ml) who visited xx Hospital between June 2022 and December 2023 were enrolled. Patients were randomly assigned using a random number table to the 1470 nm DiLEP group (n = 61) or the TURP group (n = 60). Perioperative variables, as well as functional outcomes and complications at 6 and 12 months postoperatively, were compared between the two groups. No statistically significant differences existed between groups at baseline for age, prostate volume, maximum urinary flow rate (Qmax), residual urine volume, International Prostate Symptom Score (IPSS), or quality of life (QoL) scores (P > 0.05). The 1470 nm DiLEP group demonstrated significantly shorter operative time, smaller hemoglobin decrease, lower sodium decrease, shorter catheterization duration, and shorter hospitalization compared to the TURP group (P < 0.05); There were no statistically significant differences between the two groups in Qmax, residual urine volume, IPSS, QoL, Transient stress urinary incontinence (SUI), or bladder neck contracture at 6 and 12 months postoperatively (P > 0.05). However, the incidence of retrograde ejaculation at 6 and 12 months postoperatively was significantly lower in the 1470 nm DiLEP group compared to the TURP group, while IIEF-5 scores were markedly improved (P < 0.05). 1470 nm DiLEP and TURP demonstrate comparable efficacy in patients with large-volume BPO. However, 1470 nm DiLEP offers superior safety, faster postoperative recovery, and minimal impact on sexual function. It is therefore more suitable for patients with large-volume BPO who maintain certain expectations for postoperative sexual function.