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Updated: Aug 9, 2025
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Holmium laser enucleation of the prostate (HoLEP) is safe and effective in patients with high comorbidity burden
Fabrizio Di Maida1, Antonio Andrea Grosso1, Riccardo Tellini1
1Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
Insights
Holmium laser enucleation of the prostate (HoLEP) is safe and effective for benign prostatic hyperplasia (BPH) even in patients with significant comorbidities. This procedure demonstrates comparable outcomes and complication rates across different comorbidity levels.
Area of Science:
- Urology
- Surgical Innovation
- Patient Outcomes
Background:
- Benign prostatic hyperplasia (BPH) affects a significant portion of the aging male population.
- Treatment options for BPH must consider patient comorbidities.
- Holmium laser enucleation of the prostate (HoLEP) is an established BPH treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of HoLEP in patients with a high comorbidity burden.
- To compare HoLEP outcomes in patients with Charlson Comorbidity Index (CCI) ≥ 3 versus CCI < 3.
Main Methods:
- Prospective data collection from 305 BPH patients treated with HoLEP.
- Patients stratified based on CCI (≥ 3 vs. < 3).
- Assessment of perioperative data and 3-month functional outcomes.
Main Results:
- Higher energy delivery and lasing time observed in the high comorbidity group (CCI ≥ 3).
- Comparable surgical times, intraoperative and postoperative complication rates between groups.
- No significant differences in 3-month functional outcomes (voiding symptoms, Qmax) between CCI groups.
Conclusions:
- HoLEP is a safe and effective treatment for BPH, irrespective of patient comorbidity burden.
- The procedure yields similar functional results and complication profiles in patients with high versus low comorbidities.
- HoLEP offers a viable therapeutic option for complex BPH cases.
Introduction:
We assessed the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in patients with high comorbidity burden.
Materials And Methods:
Data from patients treated with HoLEP at our academic referral center from March 2017 to January 2021 were prospectively collected. Patients were divided according to their CCI (Charlson Comorbidity Index). Perioperative surgical data and 3-month functional outcomes were collected.
Results:
Out of 305 patients included, 107 (35.1%) and 198 (64.9%) were classified as CCI ≥ 3 and < 3, respectively. The groups were comparable in terms of baseline prostate size, symptoms severity, post-void residue and Qmax. The amount of energy delivered during HoLEP (141.3 vs. 118.0 KJ, p=0.01) and lasing time (38 vs 31 minutes, p=0.01) were significantly higher in patients with CCI ≥ 3. However, median enucleation, morcellation and overall surgical time were comparable between the two groups (all p>0.05). Intraoperative complications rate (9.3% vs. 9.5%, p=0.77), median time to catheter removal and hospital stay were comparable between the two cohorts. Similarly, early (30 days) and delayed (>30 days) surgical complications rates were not significantly different between the two groups. At 3-month follow up, functional outcomes using validated questionnaires did not differ between the two groups (all p>0.05).
Conclusions:
HoLEP represents a safe and effective treatment option for BPH also in patients with high comorbidity burden.
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