Outcomes in patients undergoing benign prostatic hyperplasia surgical re-treatment with holmium laser enucleation of the prostate compared to treatment-naïve patients

BACKGROUND: Minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) are increasingly utilized but may have limited long-term durability, leading some patients to require re-treatment. Holmium laser enucleation of the prostate (HoLEP) is a size-independent option, but outcomes after prior BPH intervention remain incompletely characterized. We compared perioperative, postoperative, and functional outcomes of HoLEP in re-treatment versus treatment-naïve HoLEP. METHODS: We performed a retrospective cohort study of patients undergoing HoLEP at a tertiary center between February 2021 and August 2025. Patients with prior surgical or minimally invasive BPH interventions were propensity score-matched 1:1 to treatment-naïve patients by prostate specimen weight. Perioperative variables, postoperative outcomes, and functional measures were compared. RESULTS: We identified 418 re-treatment patients who were matched to 418 treatment-naïve controls. Re-treatment patients were older and had higher rates of prior urinary retention and urinary tract infection. Operative time, laser energy usage, and intraoperative complication rates were similar between cohorts. Overall, 90-day complication rates did not differ (6.5% vs. 5.5%, p = 0.66), though emergency department visits were more frequent in re-treatment patients (9.1% vs. 5.3%, p = 0.044). Both groups experienced comparable improvements in American Urological Association symptom and quality of life scores. Postoperative Michigan Incontinence Symptom Index severity scores were lower in the re-treatment cohort (4.9 ± 6.1 vs. 6.4 ± 6.5, p = 0.038). CONCLUSIONS: HoLEP performed after prior BPH intervention demonstrates perioperative safety and functional outcomes comparable to treatment-naïve HoLEP, supporting its role as a durable and effective treatment for recurrent or persistent BPH symptoms.