Clinical characteristics and outcomes of men <60 years undergoing HoLEP: A retrospective single-center study

Data on holmium laser enucleation of the prostate (HoLEP) in men ≤60 are limited. This study aimed to characterize the clinical presentation and outcomes of this population.

This retrospective study comprised 750 consecutive HoLEPs between 1/2020 and 11/2024. Patients were categorized by age: ≤60, 61-70, 71-80, and >80 years. The data retrieved from the medical records included age, International Prostate Symptom Scores (IPSS), uroflowmetry, preoperative prostate volume (via abdominal ultrasound), comorbidities, previous prostate surgery, presence of a preoperative indwelling urinary catheter or chronic retention, bladder stones, operative time, complications, hospital stay, and outcome.

Presentation with absolute indication (indwelling catheter and/or chronic retention) was more prevalent in the ≤60 and >80 age groups (p <0.001). The youngest group had smaller prostate volume (78 vs 90 ml, p = 0.004), fewer comorbidities, shorter surgery (70 vs 90 minutes, p <0.001), lower "beach balls" rate (2% vs 15%, p = 0.008), and shorter hospitalization (1 vs 1.5 days, p <0.001). Younger patients had lower postoperative IPSS (4 vs 7 points, p = 0.036), while the quality of life scores were similar. The overall rate of incidental prostate cancer increased with age, but not significantly. The youngest group presented with only International Society of Urological Pathology (ISUP) 1, while older groups had a higher rate of ISUP grade ≥2 (0 vs 18-25%, p <0.05). Complications were similar across age groups.

HoLEP is an effective treatment for men of all ages. Men under 60 or over 80 were more frequently treated for absolute indications, while those aged 61-80 were more often treated for relative indications.