Clinical comparison of TURP, PVP and holep for small volume BPH

This retrospective study compares the efficacy and safety of transurethral resection of the prostate (TURP), green-light photoselective vaporization of the prostate (PVP), and holmium laser enucleation of the prostate (HoLEP) in treating small-volume benign prostatic hyperplasia (BPH). Data from 645 patients with small-volume BPH (2012-2022, Zhejiang Provincial People's Hospital) were analyzed. Baseline characteristics, surgical details, complications, and follow-up outcomes were compared. Logistic regression identified risk factors for urinary incontinence (UI) and bladder neck contracture (BNC). TURP was associated with a longer operative duration (53.15 ± 21.96 min) and catheterization time (5.29 ± 1.31 days) compared to PVP (48.53 ± 22.38 min, 4.84 ± 1.05 days) and HoLEP (45.00 ± 19.04 min, 4.79 ± 0.96 days). The incidence of BNC was significantly higher in the TURP group (9.4%) than in the PVP (4.8%) and HoLEP (5.7%) groups. Within 1 month postoperatively, the TURP group had a significantly higher proportion of patients with urinary incontinence. Between 1 and 3 months post-surgery, only UI with need for drug use (UIWD) remained significantly higher in the TURP group (8.2%). Preoperative indwelling catheterization, detrusor underactivity, severely elevated detrusor pressure, and undergoing TURP were identified as independent risk factors for UI. Green-light PVP was found to be a protective factor against BNC (OR = 0.40, P = 0.043). Green-light PVP and HoLEP showed similar efficacy and safety, with PVP offering the shortest operative time. TURP was associated with higher rates of BNC and UI. Laser techniques are preferable for high-risk patients.