Comparison of low-power long-pulse width and high-power short-pulse width holmium laser enucleation of the prostate for benign prostatic hyperplasia: a retrospective study

Background: Holmium laser enucleation of the prostate (HoLEP) is an effective surgical treatment for benign prostatic hyperplasia (BPH), but the optimal laser settings remain unclear. This study compared the efficacy and safety of low-power long-pulse-width HoLEP with high-power short-pulse-width HoLEP. Methods: Clinical data from 60 patients with BPH who underwent HoLEP between June and September 2025 were retrospectively analyzed. Patients were divided into a low-power long-pulse-width group (LPL, n = 30; 1.5 J × 30 Hz, 45 W) and a high-power short-pulse-width group (HPS, n = 30; 2.0 J × 40 Hz, 80 W). Baseline characteristics, perioperative outcomes, 6-month postoperative International Prostate Symptom Score (IPSS), quality of life (QoL) score, and maximum urinary flow rate (Qmax) were compared. Results: Baseline characteristics were comparable between groups. All procedures were completed successfully, with no perioperative transfusions or severe complications. No significant between-group differences were observed in operative time, surgeon-estimated intraoperative blood loss, catheterization time, or hospital stay. At 6 months, both groups showed significant improvements in IPSS, QoL score, and Qmax compared with preoperative values, with no significant differences between groups. Conclusions: Both low-power long-pulse-width and high-power short-pulse-width HoLEP were associated with significant short-term improvements in urinary symptoms, quality of life, and urinary flow, with no statistically significant differences in the perioperative or 6-month functional outcomes analyzed. However, because of the retrospective nonrandomized design and limited sample size, these findings should not be interpreted as evidence of equivalence or noninferiority.

Benign prostatic hyperplasia; Holmium laser enucleation of the prostate; Low-power HoLEP; High-power HoLEP; Long-pulse-width laser; Short-pulse-width laser

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