Efficacy of Holmium Laser Transurethral Incision of the Prostate in Symptomatic Mild-to-Moderate Benign Prostate Enlargement Based on Preoperative Characteristics.

Objective: To investigate the efficacy of Holmium laser transurethral incision of the prostate (Ho-TUIP) with preoperative characteristics based on urodynamic parameters.

Methods: The medical records of 40 consecutive cases of Ho-TUIP in patients unresponsive to medical treatment were retrospectively reviewed. The efficacy of Ho-TUIP was analyzed according to preoperative factors, including urodynamic parameters. Treatment success was confirmed if overall efficacy demonstrated an improvement that was "good or greater" according to the criteria developed by Homma et al. Predictive factors of treatment success were analyzed using logistic regression analysis with demographics, symptom questionnaires, prostate size, and urodynamic parameters. Postoperative complications and Global Response Assessment (GRA) were investigated.

Results: Mean age was 60.9 years (range 37-84), mean follow-up period was 36.6 months (range 6.3-114.8), and mean prostate size was 23.5 mL (range 12.7-39.5). All patients underwent medical treatment before Ho-TUIP, and mean medication duration was 50.5 months (range 3.4-140.0). The treatment success rate was 60.0%. Treatment success rates were higher in the bladder outlet obstruction index (BOOI) ≥20 group (n = 26) than in the BOOI <20 group (n = 14) (p = 0.003). In logistic regression analysis, BOOI ≥20 was a predictor of treatment success (OR 7.60, 95% CI 1.60-35.90, P = 0.010). Among patients who maintained an active sex life, 77.8% (14/18) reported retrograde ejaculation. In terms of GRA, 81.5% (31/38, two patients expired) of patients improved at the final follow-up.

Conclusions: Ho-TUIP is an effective procedure with tolerable complications for the treatment of symptomatic mild-to-moderate BPE in patients with BOOI ≥20 that are unresponsive to medical treatment.