Reoperation for Benign Prostatic Obstruction Following Transurethral Resection and Holmium Laser Enucleation of the Prostate: A 3-year Follow-up Study of Over 33 000 Primary Surgical Interventions.

Objective: Large-scale studies comparing the efficacy of transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) are scarce, particularly concerning the influence of hospital volume. This study aims to evaluate the 3-yr reoperation risk for benign prostatic obstruction (BPO) following TURP versus HoLEP, adjusted for procedure-specific annual hospital volume.

Methods: This retrospective study is based on pseudonymized data from the German local health care funds (Allgemeine Ortskrankenkassen [AOK]) for BPO patients who underwent TURP (n = 29 790) or HoLEP (n = 3330) between 2017 and 2019. Three-year reoperation risk was assessed using the Kaplan-Meier (KM) method and a multivariate Cox proportional-hazard model adjusted for comorbidities. The unadjusted KM survival rate without reoperation was 93.5% (95% confidence interval [CI]: 93.2-93.7%) after TURP compared with 97.0% after HoLEP (96.3-97.5%; p < 0.001). In a multivariate analysis, HoLEP was associated with a lower reoperation risk than TURP (hazard ratio [HR] ranging from 0.23 [95% CI: 0.14-0.38] to 0.65 [95% CI: 0.42-0.98], depending on hospital volume). However, HoLEP hospital volumes of one to 49 (HR 2.74, 95% CI: 1.44-5.22) and 50-99 (HR 2.36, 95% CI: 1.27-4.39) cases annually were linked to a higher risk of reoperation than volumes of ≥250 cases, while no such volume effect was observed for TURP. The limitations of this study are the following: it is a retrospective, nonrandomized study and it lacks clinical information (eg, prostate volume and functional results).

Conclusions: HoLEP demonstrates a significantly reduced reoperation risk for BPO compared with TURP at intermediate follow-up, with dependence on procedure-specific hospital volume, which is not evident for TURP.