Comparative analysis of low-power versus high-power holmium laser enucleation of the prostate for symptomatic small-volume benign prostatic hyperplasia: a prospective randomized controlled trial

Objective To compare the safety and efficacy of low-power (LP) and high-power (HP) holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic small-volume benign prostatic hyperplasia (BPH). Methods In this prospective, multicenter, single-blind, randomized controlled trial, men with symptomatic BPH (prostate volume <40 mL, peak urinary flow rate [Qmax] <10 mL/s, International Prostate Symptom Score [IPSS] ≥18) underwent either LP (24 W) or HP HoLEP (80 W). The primary outcome was IPSS at 6 months postoperatively. Secondary outcomes included the surgical duration, total laser energy, enucleated prostate weight, patient-reported outcomes, and Clavien–Dindo classification of complications at 1, 3, and 6 months after surgery. Results Eighty-one participants completed the study. LP HoLEP used significantly less energy (22.4 ± 10.4 kJ vs. 58.6 ± 17.8 kJ). Postoperative pain was lower in the LP group at 24 and 48 hours. Both groups displayed significant improvements in outcomes versus baseline including IPSS and Qmax. The incidence of intraoperative complications was similar, though minor capsular perforation occurred exclusively in the HP group (9.8%). Conclusion LP HoLEP produced comparable clinical outcomes as HP HoLEP for small-volume BPH while using less energy, supporting its use for smaller glands.