Virtual basket mode in HoLEP: reduced early dysuria and faster continence recovery without loss of efficacy

Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH), but early postoperative dysuria and incontinence remain common concerns. The Virtual Basket (VB) mode has been proposed to reduce tissue trauma. This study evaluated whether VB use improves early postoperative recovery without compromising HoLEP efficacy.

We retrospectively analyzed 168 men who underwent HoLEP between September 2023 and September 2024. Patients were categorized into three groups according to laser settings: 100 W Standard (n = 65), 100 W VB (n = 49), and 80 W VB (n = 54). The primary outcomes were postoperative dysuria and urinary incontinence at 1 and 3 months. Secondary outcomes included catheterization time, hemoglobin drop, surgical and energy efficiency, and perioperative complications. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of persistent incontinence.

At 1 month, dysuria occurred more frequently in the Standard group (32.3%) than in the VB groups (15.6%) (p = 0.037). This difference was resolved within 3 months. Persistent urinary incontinence at 3 months was significantly lower in the VB groups (2.0% and 1.9%) compared with the Standard group (9.2%) (p = 0.031). Surgical efficiency was higher with Standard HoLEP (2.63 g/min vs. 1.8 g/min, p = 0.035), while energy efficiency was comparable across groups. The 100 W VB group had shorter catheterization times (p < 0.001) and less hemoglobin loss (p = 0.004). Logistic regression identified prostate volume as an independent predictor of incontinence (odds ratio [OR] = 1.018, 95% CI: 1.001-1.034, p = 0.035). ROC analysis demonstrated moderate predictive accuracy (area under curve [AUC] = 0.776).

VB-HoLEP significantly reduces early dysuria and accelerates continence recovery while maintaining safety and efficacy. These findings support the routine use of VB mode to improve postoperative recovery and patient satisfaction.