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<p>Holmium Laser Enucleation of the Prostate (HoLEP) has emerged as a definitive treatment for benign prostatic hyperplasia (BPH). However, the influence of laser power settings on postoperative sexual function and urinary outcomes remains controversial. This study aimed to compare high-power (HP) and low-power (LP) HoLEP in sexually active men with BPH, with a particular focus on erectile function preservation and alleviation of lower urinary tract symptoms (LUTS). In a multicenter, prospective, double-blind randomized controlled trial, 200 sexually active male patients with symptomatic BPH refractory to medical therapy were enrolled and randomly assigned to either HP-HoLEP or LP-HoLEP. Primary outcomes were assessed via changes in the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) at 1, 3, and 6 months postoperatively. Secondary endpoints included measurements of maximum urinary flow rate (Qmax), detailed operative parameters, and postoperative complications classified according to the Clavien-Dindo system. A total of 184 patients completed the study (HP group, <i>n</i> = 94; LP group, <i>n</i> = 90). Both groups exhibited significant postoperative improvements in LUTS and Qmax. A transient decline in IIEF-5 scores was observed at 1 month, with full recovery by the 3-month follow-up; no significant differences in erectile function were found between the groups at any time point. Notably, the LP group experienced longer enucleation and overall operation times but reported lower early postoperative pain scores. The complication profiles were similar between the two cohorts. Both HP-HoLEP and LP-HoLEP provide effective relief of BPH symptoms while maintaining long-term sexual function in sexually active men. The choice of laser power settings may be tailored according to patient characteristics and surgeon preference without compromising clinical outcomes. Future large-scale studies are recommended to validate these results across diverse clinical settings.</p><p><?noindent??><b>Clinical Trial Registration</b> Registration was completed on the China National Universal Health Insurance Information Platform under the identifier MR-32-20-004219.</p>

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Impact of laser power settings on sexual and urinary outcomes in holmium laser enucleation of the prostate: a multicenter randomized controlled trial

  • 期刊论文

  • 发表日期：

    2025年6月24日

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  • Ping Wang,
  • Yajun Shen,
  • Anman Hou,
  • Rong Wang

摘要

Holmium Laser Enucleation of the Prostate (HoLEP) has emerged as a definitive treatment for benign prostatic hyperplasia (BPH). However, the influence of laser power settings on postoperative sexual function and urinary outcomes remains controversial. This study aimed to compare high-power (HP) and low-power (LP) HoLEP in sexually active men with BPH, with a particular focus on erectile function preservation and alleviation of lower urinary tract symptoms (LUTS). In a multicenter, prospective, double-blind randomized controlled trial, 200 sexually active male patients with symptomatic BPH refractory to medical therapy were enrolled and randomly assigned to either HP-HoLEP or LP-HoLEP. Primary outcomes were assessed via changes in the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) at 1, 3, and 6 months postoperatively. Secondary endpoints included measurements of maximum urinary flow rate (Qmax), detailed operative parameters, and postoperative complications classified according to the Clavien-Dindo system. A total of 184 patients completed the study (HP group, n = 94; LP group, n = 90). Both groups exhibited significant postoperative improvements in LUTS and Qmax. A transient decline in IIEF-5 scores was observed at 1 month, with full recovery by the 3-month follow-up; no significant differences in erectile function were found between the groups at any time point. Notably, the LP group experienced longer enucleation and overall operation times but reported lower early postoperative pain scores. The complication profiles were similar between the two cohorts. Both HP-HoLEP and LP-HoLEP provide effective relief of BPH symptoms while maintaining long-term sexual function in sexually active men. The choice of laser power settings may be tailored according to patient characteristics and surgeon preference without compromising clinical outcomes. Future large-scale studies are recommended to validate these results across diverse clinical settings.

Clinical Trial Registration Registration was completed on the China National Universal Health Insurance Information Platform under the identifier MR-32-20-004219.