Timing of transurethral laser enucleation of the prostate after transperineal prostate biopsy: a multicenter cohort study

The optimal timing of transurethral laser enucleation of the prostate after transperineal prostate biopsy (TPB) remains uncertain. This study evaluated whether the interval between TPB and subsequent transurethral laser enucleation influences perioperative outcomes and postoperative complications. We retrospectively analyzed 168 patients who underwent TPB, had benign histopathological findings consistent with benign prostatic hyperplasia (BPH), and subsequently received transurethral laser enucleation of the prostate at the First, Third, and Fifth Medical Centers of the Chinese PLA General Hospital between January 2019 and June 2026. Patients were classified into ≤ 1-month and > 1-month groups according to the biopsy-to-surgery interval. Operative time, intraoperative blood loss, postoperative hospital stay, weight of enucleated tissue, overall procedural efficiency, postoperative residual urine volume, and perioperative complications were compared. Multivariable regression analyses were performed, followed by a subgroup analysis of patients undergoing holmium laser enucleation of the prostate (HoLEP). Among patients whose interval exceeded one month, an exploratory comparison of 1–2 months versus > 2 months was also conducted. Baseline characteristics did not differ significantly between the ≤ 1-month and > 1-month groups (all P > 0.05). In unadjusted comparisons, the ≤ 1-month group had greater intraoperative blood loss, longer operative time, lower overall procedural efficiency, and a longer postoperative hospital stay (all P < 0.05). After multivariable adjustment, surgery within one month remained independently associated with greater blood loss, longer operative time, and lower overall procedural efficiency, whereas postoperative hospital stay was no longer significantly different. In the HoLEP subgroup, surgery within one month remained independently associated with longer operative time and lower overall procedural efficiency, but not with blood loss or postoperative hospital stay. In the exploratory comparison of 1–2 months versus > 2 months, none of the adjusted perioperative outcomes differed significantly between groups. A biopsy-to-surgery interval of less than one month was associated with greater intraoperative blood loss, longer operative time, and lower overall procedural efficiency. For patients requiring timely surgical treatment, an interval of 1–2 months after TPB may provide a reasonable balance between post-biopsy recovery and symptom burden, while a longer interval may be considered on an individualized basis for technically demanding cases.