Mini-HoLEP (MILEP) vs HoLEP: a propensity score-matched analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Minimal invasiveness is crucial for surgical outcomes in urology.
• Holmium laser enucleation of the prostate (HoLEP) is a standard treatment for benign prostatic hyperplasia.
• Assessing miniaturized techniques is essential for improving patient care.

Purpose of the Study:

• To evaluate the intraoperative performance and clinical outcomes of miniaturized holmium laser enucleation of the prostate (MiLEP) using a 22-French (FR) system.
• To compare MiLEP (22 FR) with the standard 26-FR holmium laser enucleation of the prostate (HoLEP).

Main Methods:

• A propensity score-matched analysis was conducted on consecutive laser enucleations of the prostate.
• Two matched groups were formed: MiLEP (22 FR, n=40) and HoLEP (26 Fr, n=40).
• Statistical analysis was performed to compare outcomes between the two groups.

Main Results:

• MiLEP demonstrated significantly less intraoperative irrigation (15 L vs. 20.5 L) and a smaller decrease in body core temperature (0.1°C vs. 0.6°C).
• The need for meatal dilation was significantly lower in the MiLEP group (25% vs. 78%).
• A trend towards less early postoperative stress incontinence was observed in the MiLEP group, with no significant differences in effectiveness, operative time, hospital stay, or complications.

Conclusions:

• Miniaturized holmium laser enucleation of the prostate (MiLEP) is a feasible technique.
• MiLEP offers advantages in maintaining body core temperature, reducing irrigation fluid, and minimizing the need for meatal dilation compared to HoLEP.
• MiLEP may lead to reduced early postoperative stress incontinence and a shorter recovery period without compromising efficacy.