Assessing the Durability of Selective Median Lobe Holmium Laser Enucleation of the Prostate: A Retrospective Cohort...

To assess selective median lobe holmium enucleation of the prostate (MHoLEP) durability at 1 year and beyond and identify factors associated with reoperation due to benign prostate hyperplasia treatment failure.

Patients of 2 urological surgeons at a single institution who underwent MHoLEP and standard HoLEP between April 2019 and May 2024 were retrospectively reviewed. Patients with less than 1 year of follow up were excluded from durability assessment. Kaplan-Meier estimates, nonparametric tests assessing unadjusted group differences, and multivariate logistic regression were used as indicated.

One hundred twenty MHoLEP patients met durability inclusion criteria. Median follow up among durable patients was 31.7 months. Fifteen reoperations occurred resulting in 87.5% (CI: 81%-95%) MHoLEP durability for the cohort. One-year postoperative durability was 98% (CI: 95%-99.9%). No preoperative patient factors were identified that were associated with reoperations in both the unadjusted and covariate adjusted statistical analysis. Elevated postvoid residuals shortly post-MHoLEP correlated with future reoperation.

MHoLEP has reduced adverse effects to standard HoLEP and robust 1-year durability. Unfortunately, longer-term durability is weaker and inferior to standard HoLEP and there does not appear to be any patient characteristics that can be used to guide patient selection. These factors highlight the need for shared decision making when considering MHoLEP over the traditional procedure. Further studies are required to support these findings and report longer-term durability with greater confidence.