Confirming the European reality: real world experience in a 10-year single center retrospective of HoLEP vs TUR-P: the increasing value of laser enucleations at a high-throughput LUTS center

Objective: Since its introduction in 1996, laser enucleation of the prostate (LEP) has gained importance in the treatment of male lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). While the steep learning curve of LEP still keeps it from being offered on a nationwide basis, high-throughput LEP centers have formed over the past decade. Thus, we aimed to assess the change in method of choice for surgical treatment of LUTS/BPO over the past decade at our tertiary referral center. Methods: We retrospectively gathered and analyzed data from our LUTS center from 2013 to 2023 (n=4886 patients) to compare changes in the choice of surgical treatment, patient parameters, and perioperative parameters over time to assess a change in the choice of treatment from transurethral resection of the prostate (TURP) to laser enucleation techniques. Results: Average prostate volume at the time of surgery increased by approximately 25% for laser enucleation patients (79cc to 99cc), while decreasing by over 35% for TURP (48cc to 30cc). The fraction of patients receiving TURP as surgical treatment decreased almost five-fold from 76% to 18%. With the fraction of laser enucleation operations increasing from 24% to 82% respectively, the perioperative speed improving almost two-fold over time. Significance: While TURP remains the surgical reference method for LUTS/BPO, our data show a shift from the former gold standard TURP to laser techniques over a wider range of prostate volumes. This highlights the rising importance of forming high-throughput, excellency centers for laser enucleation techniques.