Comparisons of Clinical Outcomes Between the Three-Lobe and Two-Lobe Techniques in Holmium Laser Enucleation of the Prostate for Elderly Patients With Benign Prostatic Hyperplasia

To compare the clinical outcomes and urodynamic parameters of the three-lobe and two-lobe techniques of holmium laser enucleation of the prostate (HoLEP) in elderly patients with benign prostatic hyperplasia (BPH).

This retrospective study included 150 elderly patients with BPH admitted to Lishui People's Hospital between May 2021 and May 2025. Patients were divided into a control group (three-lobe technique, n = 72) and an observation group (two-lobe technique, n = 78) according to different surgical techniques. Baseline characteristics, perioperative outcomes, urodynamic parameters, health economics indicators (total hospitalisation cost and material cost), and complication rates were compared between the two groups. Univariate and multivariate linear regression analysis were used to adjust for confounding factors, including age, body mass index, preoperative prostate volume, comorbidities, and surgeon experience, and to evaluate the independent impact of the surgical technique on each outcome.

The observation group showed better results than the control group in terms of operation time, intraoperative blood loss, hospital stay, and resected prostate weight. At 6 months postoperatively, both groups showed significant improvements in International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores compared with preoperative values. The observation group showed better urodynamic parameters and a trend toward a lower complication rate, but there was no significant difference compared with the control group (p = 0.054). There was no significant difference in total hospitalisation costs and material costs between the two groups (p > 0.05). Multivariate linear regression analysis revealed that, after adjusting for confounding factors, the two-lobe technique was significantly superior to the three-lobe technique in terms of operation time, hospital stay, bladder compliance (BC), maximum cystometric capacity (BCC), and maximum urine flow rate (Q_max).

Compared with the three-lobe technique, the two-lobe HoLEP technique has certain advantages in terms of operation time, hospital stay and postoperative urodynamic parameters when treating elderly BPH. There was no statistical significance in intraoperative blood loss and complication rate. Further verification is needed in the future.