Holmium laser enucleation of the prostate versus transurethral resection of the prostate for benign prostatic hyperplasia: evidence from a Korean retrospective analysis using the Common Data Model

Background: The aim of this study was to evaluate and compare the efficacy and safety of transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) for treating benign prostatic hyperplasia using standardized multicenter data. Materials and methods: We retrospectively collected data from six Korean hospitals using the Common Data Model and performed a meta-analysis. Patients were categorized into TURP (control) and HoLEP (experimental) groups, and risk ratios were calculated to compare postoperative outcomes and complications. Sensitivity analyses were conducted by sequentially excluding each hospital's data to assess the robustness of the findings. Results: HoLEP was associated with significantly lower reoperation and transfusion rates, as well as reduced postoperative use of medications (including alpha-blockers and 5-alpha reductase inhibitors), compared to TURP. Conversely, beta-3 agonist usage was notably higher in the HoLEP group, suggesting the need for further investigation in this area. Sensitivity analyses confirmed that the overall results remained robust across individual hospital exclusions. Conclusions: The meta-analysis demonstrates that HoLEP offers superior efficacy and safety over TURP for benign prostatic hyperplasia treatment, particularly by reducing reoperation and transfusion rates and lowering long-term medication dependency. These findings support the clinical adoption of HoLEP as a viable alternative to TURP, although the increased beta-3 agonist usage in the early postoperative period merits further study.