Safety and outcomes of salvage HoLEP after TURP: a comparative study

Recurrent prostate surgery may pose additional challenges for achieving an efficient and anatomically precise enucleation. This research investigates how prior transurethral resection of prostate (TURP) affects the perioperative course, functional outcomes, and technical difficulty of Holmium Laser Enucleation of the Prostate (HoLEP) when performed as a primary procedure versus as a salvage treatment.

In this retrospective study, 174 patients who underwent HoLEP between August 2023 and April 2025 were analyzed. Group 1 included 137 patients undergoing primary HoLEP, and group 2 included 37 patients undergoing HoLEP for TURP recurrence. Outcomes assessed included enucleation weight, enucleation and morcellation time and efficiency, blood transfusion, catheter removal, and three-month postoperative International Prostate Symptom Score (IPSS), quality of life (QoL), incontinence, and urethral stricture rates.

Mean age was comparable between groups (group 1: 67.84 ± 8.67 vs. group 2: 67.24 ± 8.66 years; p = 0.840). Preoperative prostate volume and enucleation weight were higher in group 2 (81.24 vs. 67.34 mL, p = 0.012; enucleation weight, p = 0.037), while enucleation and morcellation times and efficiencies were similar. At three months, IPSS (8.31 vs. 7.19), QoL (1.56 vs. 1.58), incontinence, and urethral stricture rates did not differ significantly.

With meticulous surgical planning, HoLEP represents a safe and effective salvage procedure following TURP, maintaining functional outcomes comparable to primary intervention.