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Purpose <p>To compare immediate postoperative urinary continence and short-term functional outcomes between continence-preserving holmium laser enucleation of the prostate (HoLEP) and transurethral plasmakinetic prostatectomy (TUPKP) in patients with benign prostatic hyperplasia (BPH).</p> Methods <p>We retrospectively analyzed 212 consecutive men who underwent continence-preserving transurethral surgery for BPH at a single center between October 2024 and November 2025. Patients were grouped according to the procedure actually received (HoLEP, <i>n</i> = 109; TUPKP, <i>n</i> = 103). The primary endpoint was immediate continence after catheter removal, defined as &lt; 1&#xa0;g leakage on a standardized 1-h pad test. Pad weight was analyzed with non-parametric testing because of skewness. Multivariable logistic regression and propensity-score sensitivity analyses were used to adjust the comparison of immediate continence.</p> Results <p>Baseline characteristics were generally balanced between groups. Immediate continence was achieved in 74/109 patients after HoLEP and 33/103 patients after TUPKP (67.89% vs. 32.04%, <i>P</i> &lt; 0.001). The association remained significant after multivariable adjustment (adjusted odds ratio [OR] 9.99, 95% CI 4.56–21.86, <i>P</i> &lt; 0.001) and in a propensity-score weighted sensitivity model (OR 5.06, 95% CI 2.82–9.06, <i>P</i> &lt; 0.001). Median 1-h pad weight was lower after HoLEP (0.74&#xa0;g [IQR 0.51–1.49]) than after TUPKP (3.58&#xa0;g [IQR 0.88–6.79], <i>P</i> &lt; 0.001). At 1 month, HoLEP was associated with lower IPSS and better QoL, while Qmax was similar between groups. Bladder irrigation time, catheterization time, and postoperative hospital stay were shorter after HoLEP. A significant procedure-by-prostate-volume interaction suggested that the association between gland size and early leakage was weaker after HoLEP than after TUPKP.</p> Conclusion <p>Continence-preserving HoLEP was associated with higher immediate urinary continence and faster early postoperative recovery than continence-preserving TUPKP, while achieving similar short-term flow improvement. These findings should be interpreted as early functional outcomes from a single-center retrospective cohort; longer prospective follow-up is needed to confirm durable continence and complication profiles.</p>

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Immediate urinary continence after continence-preserving holmium laser enucleation versus transurethral plasmakinetic prostatectomy for benign prostatic hyperplasia: a single-center comparative cohort study

  • 期刊论文

  • 发表日期：

    2026年8月1日

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  • Dihao Lv,
  • Chen Gong,
  • Zhiyong Tan,
  • Chadanfeng Yang,
  • Yinglong Huang,
  • Mingxia Ding

摘要

Purpose

To compare immediate postoperative urinary continence and short-term functional outcomes between continence-preserving holmium laser enucleation of the prostate (HoLEP) and transurethral plasmakinetic prostatectomy (TUPKP) in patients with benign prostatic hyperplasia (BPH).

Methods

We retrospectively analyzed 212 consecutive men who underwent continence-preserving transurethral surgery for BPH at a single center between October 2024 and November 2025. Patients were grouped according to the procedure actually received (HoLEP, n = 109; TUPKP, n = 103). The primary endpoint was immediate continence after catheter removal, defined as < 1 g leakage on a standardized 1-h pad test. Pad weight was analyzed with non-parametric testing because of skewness. Multivariable logistic regression and propensity-score sensitivity analyses were used to adjust the comparison of immediate continence.

Results

Baseline characteristics were generally balanced between groups. Immediate continence was achieved in 74/109 patients after HoLEP and 33/103 patients after TUPKP (67.89% vs. 32.04%, P < 0.001). The association remained significant after multivariable adjustment (adjusted odds ratio [OR] 9.99, 95% CI 4.56–21.86, P < 0.001) and in a propensity-score weighted sensitivity model (OR 5.06, 95% CI 2.82–9.06, P < 0.001). Median 1-h pad weight was lower after HoLEP (0.74 g [IQR 0.51–1.49]) than after TUPKP (3.58 g [IQR 0.88–6.79], P < 0.001). At 1 month, HoLEP was associated with lower IPSS and better QoL, while Qmax was similar between groups. Bladder irrigation time, catheterization time, and postoperative hospital stay were shorter after HoLEP. A significant procedure-by-prostate-volume interaction suggested that the association between gland size and early leakage was weaker after HoLEP than after TUPKP.

Conclusion

Continence-preserving HoLEP was associated with higher immediate urinary continence and faster early postoperative recovery than continence-preserving TUPKP, while achieving similar short-term flow improvement. These findings should be interpreted as early functional outcomes from a single-center retrospective cohort; longer prospective follow-up is needed to confirm durable continence and complication profiles.