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Updated: Jun 26, 2025

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Published on: March 6, 2018

Is there a best timing for benign prostatic hyperplasia surgery?

Marc Fourmarier¹, Michael Baboudjian², Gregoire Robert³

¹Department of Urology, CH Aix-Pertuis, Aix-en-Provence, France.

The French Journal of Urology

|May 8, 2024

Summary

The optimal timing for benign prostatic hyperplasia (BPH) surgery remains debated. While early surgery offers superior efficacy, medical therapy can avoid surgical risks in selected patients with lower urinary tract symptoms (LUTS).

Keywords:

5 alpha-reductase inhibitors Alpha-blocker Benign prostatic hyperplasia Green light Holep Laser Lower urinary tract symptoms Transurethral resection of the prostate

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Area of Science:

Urology
Surgical Oncology
Geriatric Medicine

Background:

Medical therapy is now the primary treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).
Surgical intervention for BPH is typically reserved for patients unresponsive to medical management or experiencing complications.
The optimal timing for surgical intervention in LUTS/BPH requires careful consideration.

Purpose of the Study:

To discuss the optimal timing for surgical management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
To evaluate the evidence for and against early surgical treatment of BPH.

Main Methods:

A comprehensive literature search was conducted on PubMed/MEDLINE from January 1990 to January 2022.
MeSH terms included 'Lower Urinary Tract Symptoms', 'Prostatic Hyperplasia', 'Prostatic Hyperplasia/therapy', 'Prostatic Hyperplasia/complications', 'Treatment Outcome', and 'Time-to-Treatment'.
Evidence for early surgical treatment of BPH was analyzed and presented in a pros and cons format.

Main Results:

Arguments for early surgery highlight its superior efficacy and cost-effectiveness compared to medical treatment.
Early surgery may prevent worse postoperative outcomes associated with delayed intervention.
Arguments against early surgery emphasize the effectiveness of medical therapy in selected patients and the avoidance of surgical risks, including sexual side effects.

Conclusions:

Further clinical trials are needed to compare long-term outcomes of prolonged medical therapy versus early surgical treatment for BPH.
The optimal approach should consider the aging population and individual patient factors.
Patient involvement in treatment decisions is crucial.