Salvage Versus Primary Laser Enucleation of the Prostate: Are Perioperative and Functional Outcomes Comparable?

Background and Objectives: Laser enucleation of the prostate (LEP) is an established size-independent treatment for benign prostatic obstruction (BPO). However, evidence regarding salvage LEP, especially in the era of minimally invasive surgical therapies (MISTs), remains limited. We aimed to compare perioperative and short-term functional outcomes between primary and salvage LEP, including outcomes according to previous BPO intervention type. Materials and Methods: We retrospectively analyzed a prospectively maintained tertiary-care database of 1675 patients who underwent LEP between November 2017 and January 2026. Patients were stratified by previous BPO intervention and, secondarily, by intervention type (MIST versus tissue-removing procedures). Baseline characteristics, perioperative variables, 30-day complications, and functional outcomes at three months were compared. Results: Overall, 1622 patients (96.8%) underwent primary LEP and 53 (3.2%) salvage LEP. Among salvage cases, 24 followed MIST and 29 followed tissue-removing procedures. Baseline characteristics were largely comparable, although patients who previously underwent a tissue-removing procedure were older (74 vs. 70 years, p = 0.048) and had smaller prostate volumes (71 vs. 80 mL, p = 0.033). Operative time, enucleation and morcellation efficiency, laser energy consumption, surgeon satisfaction, surgical technique, and 30-day complication rates did not differ between primary and salvage LEP or between salvage subgroups. At three months, patient-reported symptom and quality of life scores, residual urine, continence, medication use, catheterization, and reintervention rates were comparable. The peak urinary flow rate at discharge was lower after previous intervention (14 versus 19 mL/s; p = 0.019), primarily after MIST (13 versus 19 mL/s; p = 0.014). Conclusions: Perioperative safety and short-term functional outcomes after salvage LEP appear largely comparable to those after primary LEP, regardless of previous intervention type. Prior BPO surgery should therefore generally not preclude LEP in appropriately selected patients.