Clinical outcomes of en-bloc non-lifting anatomical enucleation in day-case laser surgery for benign prostatic hyperplasia: a comparative study of HoLEP and ThuLEP

Clinical outcomes of en-bloc non-lifting anatomical enucleation in day-case laser surgery for benign prostatic hyperplasia: a comparative study of HoLEP and ThuLEP | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical outcomes of en-bloc non-lifting anatomical enucleation in day-case laser surgery for benign prostatic hyperplasia: a comparative study of HoLEP and ThuLEP Wan-Zhang Liu, An-Qi Shao, Bin-Bin Yang, Ze-Jun Yan, Jun-Hai Qian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8659895/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The study aimed to compare the efficacy, perioperative outcomes, and safety of en-bloc non-lifting anatomical laser enucleation using holmium (HoLEP) and thulium (ThuLEP) systems in a day-case setting, and to evaluate its feasibility for ambulatory management of benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed on 127 consecutive patients who underwent day-case en-bloc non-lifting laser enucleation for BPH from January 2022 to July 2025. Patients with prior prostate or urethral surgery, or ongoing antiplatelet therapy were excluded. Perioperative parameters, including operative time, enucleated tissue weight, hemoglobin reduction, catheterization time, and complications (classified by the Clavien–Dindo system), were recorded. Postoperative follow-up was conducted at 2, 6, and 12 weeks. Statistical analyses were performed using SPSS version 26.0, with p < 0.05 indicating significance. Result: A total of 67 HoLEP and 60 ThuLEP procedures were performed using the en-bloc non-lifting anatomical technique. The two groups were comparable in baseline characteristics. Operative time and hemoglobin decrease were similar between groups, although the mean resected tissue weight was significantly greater in the HoLEP group (p < 0.01). Postoperative recovery was rapid, with 85.0% of patients discharged within 24 hours and 95.3% within 48 hours; catheter removal was achieved in 67.7% on postoperative day 1 and in 97.6% by day 3. The overall perioperative complication rate was 11.8%, with no severe adverse events, and no significant difference between the two laser systems (p > 0.05). Both procedures resulted in substantial functional improvement, as reflected by significant reductions in IPSS and QoL scores and a more than threefold increase in Qmax (all p < 0.01). Conclusion: The en-bloc non-lifting anatomical laser enucleation technique offered a safe, efficient, and anatomically precise solution for day-case BPH surgery, achieving rapid recovery and comparable results with both holmium and thulium lasers. En-bloc non-lifting laser enucleation day-case surgery benign prostatic hyperplasia 1. Introduction Benign prostatic hyperplasia (BPH) was a common condition in aging men, and a substantial proportion of patients eventually required invasive intervention to alleviate lower urinary tract symptoms. Recent evidence demonstrated that day-case endoscopic enucleation of the prostate, including holmium (HoLEP) and thulium (ThuLEP) laser techniques, was both safe and feasible for appropriately selected BPH patients. Systematic reviews reported comparable complication and 30-day readmission rates between day-case and conventional inpatient pathways [ 1 ] . The most common causes of unplanned admission following day-case surgery included postoperative hematuria, acute urinary retention requiring recatheterization, and, less frequently, transfusion or reoperation [ 2 ] . Predictors of unsuccessful same-day discharge were associated with larger prostate volume, longer operative time, greater perioperative hemoglobin decline, anticoagulant use, and limited surgeon experience [ 3 ] . In recent years, the en-bloc non-lifting laser enucleation technique emerged as a refined form of anatomical endoscopic enucleation. By maintaining precise dissection along the prostatic capsule without mechanically elevating the adenoma, this approach reduced traction-related tissue injury and enhanced intraoperative visibility. Studies reported that non-lifting enucleation with holmium or thulium lasers provided shorter operative times, reduced blood loss, and equivalent functional outcomes compared with traditional multi-lobe techniques [ 4 – 7 ] . Moreover, it offered improved hemostasis, shorter catheterization time, and facilitated same-day or early discharge, supporting the evolution toward minimally invasive, ambulatory management of BPH [ 8 , 9 ] . Although holmium laser–based dissection without mechanical lifting had demonstrated excellent outcomes in the management of BPH, evidence regarding its application in a day-case setting was still limited. Furthermore, the thulium laser had shown high efficacy in tissue incision and hemostasis since its introduction. Building upon this evidence, the present study adopted an en-bloc non-lifting anatomical enucleation technique in a day-case context and directly compared HoLEP and ThuLEP. The study aimed to evaluate and compare the clinical outcomes, perioperative efficiency, and safety profiles of these two laser systems, thereby exploring the feasibility and potential advantages of the non-lifting anatomical approach in day-case prostate surgery. 2. Methods 2.1. Study design This study was approved by the Ethical Committee of the First Affiliated Hospital of Ningbo University. All of the informed consents were written by the patients. From January 2022 to July 2025, a total of 127 consecutive patients who underwent day-case en-bloc non-lifting laser enucleation for BPH were retrospectively analyzed, including 67 HoLEP (Group A) and 60 ThuLEP (Group B) procedures. Inclusion criteria were: (1) diagnosis of symptomatic BPH confirmed by clinical evaluation and imaging; (2) prostate volume ≥30 mL; and (3) completion of day-case laser enucleation using the en-bloc non-lifting anatomical technique. Exclusion criteria included: (1) patients receiving continuous antiplatelet or anticoagulant therapy during the perioperative period; (2) history of prostate or urethral surgery; (3) concomitant urethral stricture, or suspected prostate malignancy; and (4) cases in which mechanical enucleation or morcellation techniques other than laser dissection were employed. Demographic and clinical data were collected, including patient age, comorbidities, history of preoperative catheterization, post-voiding residue (PVR) volume, International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, and maximum urinary flow rate (Qmax). Laboratory and diagnostic parameters, such as serum prostate-specific antigen (PSA), complete blood count, urinalysis, and prostate volume, were also recorded. Intraoperative and postoperative parameters were evaluated, including total operative time, weight of enucleated tissue, duration of postoperative catheterization, hemoglobin reduction, intraoperative and postoperative complications, need for blood transfusion, recatheterization for urinary retention or gross hematuria, and reoperation for postoperative bleeding. Postoperative complications were recorded and classified according to the Clavien-Dindo grading system [10] , which categorizes surgical complications based on the required level of intervention. 2.2. Surgical techniques 2.2.1 Anesthesia and Positioning All procedures were performed under general anesthesia by two senior urologists experienced in BPH surgery. Patients were positioned in the lithotomy position, and a 26-Fr resectoscope sheath was used for all operations. 2.2.2 Laser Equipment and Settings For Group A, a Raykeen Holmium:YAG laser system (Raykeen, China) equipped with a 550-μm end-firing fiber was used. The laser was set at a power of 60–80 W (frequency 30–40 Hz, pulse energy 2.0 J) for tissue dissection and 15–30 W (frequency 25–30 Hz, pulse energy 0.6–1.0 J) for hemostasis. For Group B, a Raykeen Thulium laser system (Raykeen, China) with the same 550-μm fiber was applied, operating at a power of 50–60 W for enucleation and 20–30 W for hemostasis. 2.2.3 Enucleation Procedures The procedure began approximately 5 mm distal to the verumontanum, where a circumferential mucosal incision was made at the apex of the prostate to delineate the surgical boundary. The apical structures were carefully preserved to prevent external sphincter injury. The dissection plane was then deepened to the prostatic pseudocapsule, and enucleation was performed along this plane using laser vaporization and fragmentation. Excessive mechanical manipulation or “lifting” of the prostatic tissue was intentionally avoided, and enucleation was achieved primarily through the laser’s cutting and coagulative effects. An en-bloc approach was preferred throughout the procedure. After complete enucleation of the adenoma, the dissection was advanced through the 12 o’clock position at the junction between the bladder neck and the prostatic tissue to enter the bladder, thereby minimizing the risk of injury to the prostatic capsule or bladder base. In cases where entry at the bladder neck was difficult, additional incisions were made at the 5 o’clock or 7 o’clock positions to re-enter the capsular plane. The resected tissue fragments were subsequently retrieved using a mechanical morcellator. 2.2.4 Hemostasis and Postoperative Management Before completion of the procedure, point coagulation was applied to the prostatic fossa to control active bleeding. Once satisfactory hemostasis was achieved and the irrigation fluid appeared clear, a 22-Fr three-way Foley catheter was inserted and secured to prevent displacement. Continuous low-pressure bladder irrigation with normal saline was maintained for approximately 6-8 hours postoperatively. Irrigation was discontinued when the effluent remained clear; in cases of persistent hematuria, gentle traction on the catheter and continued irrigation were maintained until the effluent color stabilized. 2.3 Postoperative Care and Follow-up Patients were observed in the hospital for one night after surgeries, and discharge was permitted if no severe gross hematuria, blood clots, or worsening bleeding were noted. The urethral catheter was typically retained for 1–3 days after surgery. If the urine remained clear for more than 6–8 consecutive hours, catheter removal was considered. Upon discharge, patients were provided with follow-up contact information and were scheduled for an online consultation the following day to assess their voiding status and the presence of hematuria. All patients were advised to return for routine follow-up visits at 2, 6, and 12 weeks postoperatively. Follow-up evaluations included IPSS, QoL, Qmax, complete blood count, urinalysis, and PVR measured by ultrasonography. 2.4 Statistical analysis All statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) and compared between groups using the independent-samples t-test or Mann–Whitney U test, depending on data distribution. Categorical variables were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square (χ²) test or Fisher’s exact test when the expected frequency was less than 5. A P value of less than 0.05 was considered statistically significant. 3. Results 3.1 Patient Characteristics A total of 127 patients were included in the present study, comprising 67 in Group A and 60 in Group B. The two groups were comparable in terms of baseline demographics and preoperative clinical characteristics, including age, prostate volume, serum PSA level, and urinary parameters such as IPSS, QoL score, and Qmax. The incidence of preoperative urinary retention was also similar between the groups. No statistically significant differences were observed for any baseline variable (all p > 0.05) (Table.1). 3.2 Overall Operative Outcomes Within 24 hours postoperatively, 108 patients (85.0%) were discharged, and a total of 95.3% were discharged within 48 hours. Catheter removal was successfully achieved in 86 patients (67.7%) on postoperative day 1 and in 124 patients (97.6%) by day 3. Overall, 15 patients (11.8%) experienced perioperative complications, including 9 (7.1%) classified as Clavien–Dindo Grade I–II and 6 (4.7%) as Grade III. No severe adverse events (Grade IV–V) were reported. Comparison of pre- and postoperative outcomes across the entire cohort demonstrated significant improvements in lower urinary tract symptoms and urinary flow following non-lifting anatomical laser enucleation of the prostate. Both mean IPSS and QoL scores were markedly reduced, while Qmax increased by more than threefold postoperatively (Table.2). 3.3 Comparison of Surgical Outcomes Between the Two Groups Operative time and hemoglobin decrease did not differ significantly between Group A and B. However, the amount of resected prostatic tissue was significantly greater in the Group A (p < 0.01). Both groups achieved comparable postoperative functional improvements, with pronounced reductions in IPSS and QoL scores and substantial increases in Qmax. The extent of improvement in IPSS, QoL, and Qmax did not differ significantly between the two laser systems (all p > 0.05). Most patients were discharged within 24 hours after surgery (91.0% in the Group A and 78.3% in Group B; p = 0.08), and the overall 48-hour discharge rate exceeded 95% in both groups, with no significant difference observed. Similarly, the duration of catheterization and early postoperative recovery parameters were comparable between groups (Table.3). Although Group A demonstrated a higher rate of successful discharge and catheter removal within 24 hours, the differences were not statistically significant. 3.4 Comparison of Postoperative Complications Between the Two Groups The overall complication rate was 7.5% in Group A and 16.7% in Group B. Although complications occurred more frequently in Group B, the difference did not reach statistical significance (p = 0.13) (Table.3). In Group A, one patient experienced transient hematuria requiring observation (Grade I), and one had a low-grade postoperative fever (Grade I). Urinary retention requiring recatheterization occurred in one patient (Grade I), while one patient developed postoperative bleeding in 7 days requiring catheterization (Grade IIIa). One patient developed a urethral orifice stricture requiring surgical intervention (Grade IIIb). In Group B, hematuria requiring observation occurred in two patients (Grade I), urinary retention requiring recatheterization in two (Grade I), and postoperative bleeding within 7 days in two (Grade IIIa). Two patients developed transient stress urinary incontinence requiring medication (Grade II). One patient experienced urethral stricture managed with urethral dilation (Grade IIIa), and one developed bladder neck contracture necessitating resection (Grade IIIb). No Grade IV or V complications were observed in either group. 4. Discussion In this three-year retrospective study, laser-driven non-lifting anatomical enucleation of the prostate using both holmium and thulium laser systems demonstrated favorable safety and efficacy outcomes in a day-case setting. The non-lifting approach, characterized by the use of precise laser incision and vaporization rather than blunt mechanical dissection for adenoma removal, allowed for controlled tissue separation with optimal preservation of the apical prostatic tissue and urethral sphincter complex. This technique likely contributed to reduced traction-related trauma, minimized intraoperative bleeding, and earlier recovery of urinary continence, consistent with previously reported findings [7,9] . Over the study period, the non-lifting anatomical enucleation technique was successfully applied in 127 consecutive day-case procedures. A high proportion of patients (85%) were discharged within 24 hours (91% in HoLEP and 78% in ThuLEP), and more than 95% within 48 hours, underscoring the feasibility of same-day discharge for appropriately selected patients. The overall perioperative complication rate was 11.8%, with no Clavien–Dindo Grade IV or V events, and no patient required blood transfusion or reoperation for hemostasis. These results indicated that both HoLEP and ThuLEP performed with the non-lifting anatomical enucleation technique were safe and effective for day-case management, yielding high early discharge rates and favorable complication profiles. The outcomes observed in our series are comparable to, or even surpass, those reported in previous studies, where same-day discharge rates ranged from 70% to 87% and readmission or complication rates varied between 0% and 17.8% [11,12] . Although both holmium and thulium laser systems achieved comparable postoperative functional improvements in this study, several technical distinctions might explain the subtle differences in operative performance. The thulium laser, characterized by continuous-wave emission and superior coagulation, tended to produce a broader eschar zone along the resection plane, which could occasionally obscure the prostatic capsule and lead to minor loss of the enucleation layer [13,14] . This effect might account for the smaller amount of resected tissue observed in the ThuLEP group compared with the HoLEP group, suggesting a potential risk of incomplete adenoma removal. In addition, the higher vaporization efficiency of the thulium laser likely contributed to the reduced specimen weight, as part of the prostatic tissue was vaporized during enucleation. In some cases, limited blunt manipulation was required to re-establish the correct anatomical plane during ThuLEP. These findings aligned with previous studies reporting that HoLEP and ThuLEP yield similar long-term symptom and flow improvements, while small variations in operative efficiency were likely attributable to differences in laser–tissue interaction rather than surgical technique [15,16] . Regarding early postoperative recovery, the HoLEP group showed a higher proportion of patients discharged and catheter-free within 24 hours, though the difference was not statistically significant. The earlier establishment of HoLEP at our center could have contributed to smoother perioperative management compared with ThuLEP program. Despite comparable intraoperative blood loss between the two groups, mild hematuria on the first postoperative day occurred more frequently after ThuLEP. This phenomenon was likely related to minor tissue residuals and occasional mechanical manipulation during capsule localization, rather than to any intrinsic limitation in the hemostatic capability of the thulium laser. Similar findings had been reported in prior studies, where transient hematuria occurred slightly more often after ThuLEP despite equivalent catheterization times and bleeding control [17,18] . Collectively, these results suggested that while both laser systems were safe and effective for day-case prostate enucleation, HoLEP might offered marginal advantages in operative efficiency and early recovery, particularly during the initial adoption phase of ThuLEP. Recent studies had reported that early catheter removal after endoscopic enucleation of the prostate—particularly when using anatomical or non-lifting techniques—achieves success rates of 85–94%, with urinary retention rates as low as 3–8%, and minor hematuria being the most common transient event [11,19,20] . However, there remained no standardized definition regarding the optimal duration of postoperative catheterization. In our cohort of 127 patients, catheter removal was attempted once the urine remained clear for 6–8 consecutive hours. Overall, 67.7% of patients successfully underwent catheter removal on postoperative day one (71.6% in the HoLEP group and 63.3% in the ThuLEP group, respectively). Three patients required re-catheterization—two due to transient urinary retention, managed with a temporary 16Fr Foley catheter, and one due to persistent gross hematuria who remained hospitalized for observation. For patients whose urine remained mildly blood-tinged but without fresh clots on postoperative day one, we adopted a “home-catheterization” approach, allowing discharge with the catheter in situ and daily online follow-up assessments. This strategy was proven safe and effective in maintaining patient comfort, minimizing unnecessary hospitalization, and optimizing resource utilization, consistent with previous reports supporting outpatient catheter management after laser prostate enucleation [21,22] . Postoperative complication rates in both the HoLEP and ThuLEP groups were low and mostly mild, which aligned well with findings from previous meta-analyses and systematic reviews [11] . Reported rates of transfusion-requiring bleeding and major hemorrhagic events were below 3–5%, urinary retention necessitating re-catheterization occurred in 3–8% of cases, transient urinary incontinence in 5–10%, urinary tract infections in 2–6%, and urethral or bladder neck strictures in less than 2%. In our cohort, the overall complication spectrum was comparable, and no statistically significant differences were observed between the two procedures. Among the two patients who required re-catheterization for postoperative urinary retention, one had preoperative AUR, likely leading to incomplete detrusor recovery [23] , whereas the other had a relatively small prostate (31 ml) and experienced transient obstruction secondary to localized postoperative edema [24,25] . Consistent with prior reports, these observations suggest that a slightly prolonged catheterization period in selected patients—particularly those with preoperative AUR or small prostate volumes—may help lower the risk of recurrent retention and related complications. Postoperative urinary incontinence represented another important consideration. In our cohort, two patients in the ThuLEP group experienced transient stress urinary incontinence, which was likely related to early-stage learning curve factors, including slight mechanical manipulation during capsule dissection and longer operative times. Both cases were managed conservatively with pharmacologic therapy (duloxetine), and continence fully recovered within three months. Previous studies have reported similar incidences of transient urinary incontinence following laser enucleation procedures, particularly during the initial adoption phase, and emphasized that conservative management—including observation, pelvic floor exercises, and, when indicated, pharmacotherapy—usually leads to full recovery without the need for surgical intervention [26] . This study had several limitations. First, it was a single-center retrospective analysis evaluating the safety and efficacy of the non-lifting laser enucleation technique in day-case management of BPH using different laser modalities. Therefore, potential selection and recall biases could not be fully eliminated. Multicenter, prospective, and randomized comparative studies were warranted to further validate our findings and establish stronger evidence for the generalizability of this technique. Second, to ensure perioperative safety, only patients with relatively good overall health and limited comorbidities were selected for the day-case procedure in our outpatient pre-admission system. Consequently, the applicability, safety, and outcomes of this technique in higher-risk populations—such as those with significant cardiovascular disease, ongoing anticoagulant therapy, or impaired renal function—remain uncertain. Future research should therefore include a broader spectrum of patients and incorporate standardized preoperative risk assessment models to refine selection criteria for day-case endoscopic enucleation. Additionally, the study lacked long-term functional follow-up and detailed cost-effectiveness analysis, which may further elucidate the advantages of this minimally invasive, same-day approach. 5. Conclusion The non-lifting laser enucleation technique represented an innovative refinement of anatomical endoscopic prostate surgery, emphasizing precise capsule-based dissection without mechanical traction. In our experience, this approach demonstrated excellent safety, hemostatic control, and early recovery profiles within a day-case setting using both holmium and thulium laser systems. These findings supported its feasibility and short-term efficacy; however, further multicenter, prospective research with extended follow-up and inclusion of higher-risk patient populations was required to confirm its long-term safety, durability, and cost-effectiveness. Continued optimization of perioperative assessment and patient selection criteria remained essential to fully realize the advantages of this minimally invasive, same-day surgical approach for BPH. Abbreviations BPH Benign Prostatic Hyperplasia TURP Transurethral Resection of Prostate HoLEP Holmium Laser Enucleation of Prostate ThuLEP Thulium Laser Enucleation of Prostate PSA Prostate-Specific Antigen AUR Acute urinary retention PVR Post-Voiding Residue IPSS International Prostate Symptom Score QoL Quality of Life Qmax Maximum urinary flow rate Declarations Author contribution WZ Liu: Data analysis, Manuscript writing and editing; AQ Shao: Data collection and analysis; BB Yang: Data collection and management; ZJ Yan: Revision of manuscript; JH Qian: Protocol, project development. Ethics approval and consent to participate: The study (involving humans) was performed in accordance with the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of the First Affiliated Hospital of NingBo University. Informed consent to participate in the study was obtained from all the subjects. Conflict of interest: The authors declare that they have no competing interests. Consent for publication: Not applicable. Availability of Data and Materials: The datasets generated and/or analysed during the current study are not publicly available due to an agreement with the subjects but are available from the corresponding author on reasonable request. Clinical trial number: Not applicable. Acknowledgement: The authors gratefully acknowledge the contributions of the clinical and nursing teams from the Department of Urology, the First Affiliated Hospital of Ningbo University, for their support in data acquisition and patient management. The authors also thank the hospital’s clinical research center for its assistance in data analysis and coordination. Funding Information: 1. Ningbo Clinical Research Center for Urological Disease, No.2019A21001; 2. Ningbo Top Medical and Health Research Program, No.2022020203; 3. Zhejiang Engineering Research Center of Innovative technologies and diagnostic and therapeutic equipment for urinary system diseases. 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Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate. J Endourol. 2022 Jul;36(7):977-981. doi: 10.1089/end.2022.0007. Epub 2022 Jun 21. PMID: 35045752. Gordon TT, Gordon N. A 27-Year Experience With Day Surgery Transurethral Resection of the Prostate. Cureus. 2024;16(3):e55699. Published 2024 Mar 7. doi:10.7759/cureus.55699. Erazo JC, Suso-Palau D, Sejnaui JE, et al. Outpatient 180 W XPS GreenLight Laser Photoselective Vaporization of the Prostate: 7-Year Experience. J Endourol. 2022;36(4):548-553. doi:10.1089/end.2021.0618. Lee CL, Jhang JF, Ho HC, et al. Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification. Sci Rep. 2022 Jan 10;12(1):362. doi: 10.1038/s41598-021-04237-0. PMID: 35013465; PMCID: PMC8748740. Hsu YH, Hou CP, Weng SC, et al. Analysis of urinary retention after endoscopic prostate enucleation and its subsequent impact on surgical outcomes. 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Tables Table.1 Patients’ Demographics Items HoLEP (n=67) ThuLEP (n=60) statistic p Age (y) 68.3±5.7 67.9±6.0 t=0.35 p=0.72 Vol of Prostate (ml) 59.8±13.8 60.3±13.9 t=-0.23 p=0.82 PSA (ng/ml) 4.0±2.2 3.6±2.0 t=1.0 p=0.31 Pre-IPSS 18.4±4.8 18.0±5.4 t=0.43 p=0.67 Pre-QoL 4.5±1.1 4.5±1.1 t=-0.26 p=0.80 Pre-Qmax (ml/s) 7.0±3.3 6.8±3.0 t=0.34 p=0.73 Urinary Retention(n,%) 35 (52.2%) 32 (53.3%) χ²=0.03 p=0.86 Table.2 Overall Surgical outcomes for Non-lifting Laser Enucleation of Prostate Items Pre-operation Post-operation statistic p IPSS 18.2±5.1 5.9±3.1 t=25.0 p<0.01 QoL 4.5±1.1 1.2±1.0 t=26.3 p<0.01 Qmax (ml/s) 6.9±3.2 21.1±4.2 t=-30.4 p<0.01 Table.3 Operative parameters and Surgical outcomes between two groups Items HoLEP (n=67) ThuLEP (n=60) statistic p Surgical time (min) 43.5±17.4 48.4±18.1 t=-1.55 p=0.12 Cutting Tissue (g) 48.2±13.1 39.0±15.7 t=3.60 p<0.01 Dropping of Hb (g/L) 12.7±14.6 13.3±13.2 t=-0.24 p=0.81 Post- IPSS 5.8±3.1 5.9±3.2 t=-0.07 p=0.94 Post- QoL 1.1±1.0 1.3±1.1 t=-0.78 p=0.44 Post- Qmax (ml/s) 21.6±4.4 20.5±3.9 t=1.39 p=0.17 Improvement of IPSS 12.6±5.2 12.1±6.0 t=0.43 p=0.67 Improvement of QoL 3.4±1.4 3.3±1.5 t=0.34 p=0.74 Improvement of Qmax (ml/s) 14.5±5.7 13.7±4.7 t=0.90 p=0.37 24-hours discharge(n,%) 61 (91.0%) 47 (78.3%) χ²=3.06 p=0.08 48-hours discharge(n,%) 64 (95.5%) 57 (95.0%) χ²=0.45 p=0.50 1-day catheter(n,%) 48 (71.6%) 38 (63.3%) χ²=0.62 p=0.43 3-days catheter(n,%) 66 (98.5%) 58 (96.7%) χ²=0.61 p=0.44 Complications (Clavien–Dindo) (n,%) Ⅰ 3 (4.5%) 4 (6.6%) χ²=2.28 p=0.13 Ⅱ 0 (0%) 2 (3.3%) Ⅲa 1 (1.5%) 3 (5.0 %) Ⅲb 1 (1.5%) 1 (1.7%) Ⅳ 0 (0%) 0 ( 0%) Ⅴ 0 (0%) 0 (0%) Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eBenign prostatic hyperplasia (BPH) was a common condition in aging men, and a substantial proportion of patients eventually required invasive intervention to alleviate lower urinary tract symptoms. Recent evidence demonstrated that day-case endoscopic enucleation of the prostate, including holmium (HoLEP) and thulium (ThuLEP) laser techniques, was both safe and feasible for appropriately selected BPH patients. Systematic reviews reported comparable complication and 30-day readmission rates between day-case and conventional inpatient pathways\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The most common causes of unplanned admission following day-case surgery included postoperative hematuria, acute urinary retention requiring recatheterization, and, less frequently, transfusion or reoperation\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Predictors of unsuccessful same-day discharge were associated with larger prostate volume, longer operative time, greater perioperative hemoglobin decline, anticoagulant use, and limited surgeon experience\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn recent years, the en-bloc non-lifting laser enucleation technique emerged as a refined form of anatomical endoscopic enucleation. By maintaining precise dissection along the prostatic capsule without mechanically elevating the adenoma, this approach reduced traction-related tissue injury and enhanced intraoperative visibility. Studies reported that non-lifting enucleation with holmium or thulium lasers provided shorter operative times, reduced blood loss, and equivalent functional outcomes compared with traditional multi-lobe techniques\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Moreover, it offered improved hemostasis, shorter catheterization time, and facilitated same-day or early discharge, supporting the evolution toward minimally invasive, ambulatory management of BPH\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough holmium laser\u0026ndash;based dissection without mechanical lifting had demonstrated excellent outcomes in the management of BPH, evidence regarding its application in a day-case setting was still limited. Furthermore, the thulium laser had shown high efficacy in tissue incision and hemostasis since its introduction. Building upon this evidence, the present study adopted an en-bloc non-lifting anatomical enucleation technique in a day-case context and directly compared HoLEP and ThuLEP. The study aimed to evaluate and compare the clinical outcomes, perioperative efficiency, and safety profiles of these two laser systems, thereby exploring the feasibility and potential advantages of the non-lifting anatomical approach in day-case prostate surgery.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e2.1. Study design\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;This study was approved by the Ethical Committee of the First Affiliated Hospital of Ningbo University. All of the informed consents were written by the patients.\u003c/p\u003e\n\u003cp\u003eFrom January 2022 to July 2025, a total of 127 consecutive patients who underwent day-case en-bloc non-lifting laser enucleation for BPH were retrospectively analyzed, including 67 HoLEP (Group A) and 60 ThuLEP (Group B) procedures. Inclusion criteria were: (1) diagnosis of symptomatic BPH confirmed by clinical evaluation and imaging; (2) prostate volume \u0026ge;30 mL; and (3) completion of day-case laser enucleation using the en-bloc non-lifting anatomical technique. Exclusion criteria included: (1) patients receiving continuous antiplatelet or anticoagulant therapy during the perioperative period; (2) history of prostate or urethral surgery; (3) concomitant urethral stricture, or suspected prostate malignancy; and (4) cases in which mechanical enucleation or morcellation techniques other than laser dissection were employed.\u003c/p\u003e\n\u003cp\u003eDemographic and clinical data were collected, including patient age, comorbidities, history of preoperative catheterization, post-voiding residue (PVR) volume, International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, and maximum urinary flow rate (Qmax). Laboratory and diagnostic parameters, such as serum prostate-specific antigen (PSA), complete blood count, urinalysis, and prostate volume, were also recorded.\u003c/p\u003e\n\u003cp\u003eIntraoperative and postoperative parameters were evaluated, including total operative time, weight of enucleated tissue, duration of postoperative catheterization, hemoglobin reduction, intraoperative and postoperative complications, need for blood transfusion, recatheterization for urinary retention or gross hematuria, and reoperation for postoperative bleeding. Postoperative complications were recorded and classified according to the Clavien-Dindo grading system\u003csup\u003e[10]\u003c/sup\u003e, which categorizes surgical complications based on the required level of intervention.\u003c/p\u003e\n\u003cp\u003e2.2. Surgical techniques\u003c/p\u003e\n\u003cp\u003e2.2.1 Anesthesia and Positioning\u003c/p\u003e\n\u003cp\u003eAll procedures were performed under general anesthesia by two senior urologists experienced in BPH surgery. Patients were positioned in the lithotomy position, and a 26-Fr resectoscope sheath was used for all operations.\u003c/p\u003e\n\u003cp\u003e2.2.2 Laser Equipment and Settings\u003c/p\u003e\n\u003cp\u003eFor Group A, a Raykeen Holmium:YAG laser system (Raykeen, China) equipped with a 550-\u0026mu;m end-firing fiber was used. The laser was set at a power of 60\u0026ndash;80 W (frequency 30\u0026ndash;40 Hz, pulse energy 2.0 J) for tissue dissection and 15\u0026ndash;30 W (frequency 25\u0026ndash;30 Hz, pulse energy 0.6\u0026ndash;1.0 J) for hemostasis.\u003c/p\u003e\n\u003cp\u003eFor Group B, a Raykeen Thulium laser system (Raykeen, China) with the same 550-\u0026mu;m fiber was applied, operating at a power of 50\u0026ndash;60 W for enucleation and 20\u0026ndash;30 W for hemostasis.\u003c/p\u003e\n\u003cp\u003e2.2.3 Enucleation Procedures\u003c/p\u003e\n\u003cp\u003eThe procedure began approximately 5 mm distal to the verumontanum, where a circumferential mucosal incision was made at the apex of the prostate to delineate the surgical boundary. The apical structures were carefully preserved to prevent external sphincter injury. The dissection plane was then deepened to the prostatic pseudocapsule, and enucleation was performed along this plane using laser vaporization and fragmentation.\u003c/p\u003e\n\u003cp\u003eExcessive mechanical manipulation or\u0026nbsp;\u0026ldquo;lifting\u0026rdquo;\u0026nbsp;of the prostatic tissue was intentionally avoided, and enucleation was achieved primarily through the laser\u0026rsquo;s cutting and coagulative effects. An en-bloc approach was preferred throughout the procedure. After complete enucleation of the adenoma, the dissection was advanced through the 12 o\u0026rsquo;clock position at the junction between the bladder neck and the prostatic tissue to enter the bladder, thereby minimizing the risk of injury to the prostatic capsule or bladder base. In cases where entry at the bladder neck was difficult, additional incisions were made at the 5 o\u0026rsquo;clock or 7 o\u0026rsquo;clock positions to re-enter the capsular plane. The resected tissue fragments were subsequently retrieved using a mechanical morcellator.\u003c/p\u003e\n\u003cp\u003e2.2.4 Hemostasis and Postoperative Management\u003c/p\u003e\n\u003cp\u003eBefore completion of the procedure, point coagulation was applied to the prostatic fossa to control active bleeding. Once satisfactory hemostasis was achieved and the irrigation fluid appeared clear, a 22-Fr three-way Foley catheter was inserted and secured to prevent displacement. Continuous low-pressure bladder irrigation with normal saline was maintained for approximately 6-8 hours postoperatively. Irrigation was discontinued when the effluent remained clear; in cases of persistent hematuria, gentle traction on the catheter and continued irrigation were maintained until the effluent color stabilized.\u003c/p\u003e\n\u003cp\u003e2.3 Postoperative Care and Follow-up\u003c/p\u003e\n\u003cp\u003ePatients were observed in the hospital for one night after surgeries, and discharge was permitted if no severe gross hematuria, blood clots, or worsening bleeding were noted. The urethral catheter was typically retained for 1\u0026ndash;3 days after surgery. If the urine remained clear for more than 6\u0026ndash;8 consecutive hours, catheter removal was considered.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUpon discharge, patients were provided with follow-up contact information and were scheduled for an online consultation the following day to assess their voiding status and the presence of hematuria. All patients were advised to return for routine follow-up visits at 2, 6, and 12 weeks postoperatively. Follow-up evaluations included IPSS, QoL, Qmax, complete blood count, urinalysis, and PVR measured by ultrasonography.\u003c/p\u003e\n\u003cp\u003e2.4 Statistical analysis\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean \u0026plusmn; standard deviation (SD) and compared between groups using the independent-samples t-test or Mann\u0026ndash;Whitney U test, depending on data distribution. Categorical variables were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square (\u0026chi;\u0026sup2;) test or Fisher\u0026rsquo;s exact test when the expected frequency was less than 5. A P value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 127 patients were included in the present study, comprising 67 in Group A and 60 in Group B. The two groups were comparable in terms of baseline demographics and preoperative clinical characteristics, including age, prostate volume, serum PSA level, and urinary parameters such as IPSS, QoL score, and Qmax. The incidence of preoperative urinary retention was also similar between the groups. No statistically significant differences were observed for any baseline variable (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table.1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Overall Operative Outcomes\u003c/h2\u003e \u003cp\u003eWithin 24 hours postoperatively, 108 patients (85.0%) were discharged, and a total of 95.3% were discharged within 48 hours. Catheter removal was successfully achieved in 86 patients (67.7%) on postoperative day 1 and in 124 patients (97.6%) by day 3. Overall, 15 patients (11.8%) experienced perioperative complications, including 9 (7.1%) classified as Clavien\u0026ndash;Dindo Grade I\u0026ndash;II and 6 (4.7%) as Grade III. No severe adverse events (Grade IV\u0026ndash;V) were reported.\u003c/p\u003e \u003cp\u003eComparison of pre- and postoperative outcomes across the entire cohort demonstrated significant improvements in lower urinary tract symptoms and urinary flow following non-lifting anatomical laser enucleation of the prostate. Both mean IPSS and QoL scores were markedly reduced, while Qmax increased by more than threefold postoperatively (Table.2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of Surgical Outcomes Between the Two Groups\u003c/h2\u003e \u003cp\u003eOperative time and hemoglobin decrease did not differ significantly between Group A and B. However, the amount of resected prostatic tissue was significantly greater in the Group A (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Both groups achieved comparable postoperative functional improvements, with pronounced reductions in IPSS and QoL scores and substantial increases in Qmax. The extent of improvement in IPSS, QoL, and Qmax did not differ significantly between the two laser systems (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMost patients were discharged within 24 hours after surgery (91.0% in the Group A and 78.3% in Group B; p\u0026thinsp;=\u0026thinsp;0.08), and the overall 48-hour discharge rate exceeded 95% in both groups, with no significant difference observed. Similarly, the duration of catheterization and early postoperative recovery parameters were comparable between groups (Table.3). Although Group A demonstrated a higher rate of successful discharge and catheter removal within 24 hours, the differences were not statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Comparison of Postoperative Complications Between the Two Groups\u003c/h2\u003e \u003cp\u003eThe overall complication rate was 7.5% in Group A and 16.7% in Group B. Although complications occurred more frequently in Group B, the difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.13) (Table.3).\u003c/p\u003e \u003cp\u003eIn Group A, one patient experienced transient hematuria requiring observation (Grade I), and one had a low-grade postoperative fever (Grade I). Urinary retention requiring recatheterization occurred in one patient (Grade I), while one patient developed postoperative bleeding in 7 days requiring catheterization (Grade IIIa). One patient developed a urethral orifice stricture requiring surgical intervention (Grade IIIb).\u003c/p\u003e \u003cp\u003eIn Group B, hematuria requiring observation occurred in two patients (Grade I), urinary retention requiring recatheterization in two (Grade I), and postoperative bleeding within 7 days in two (Grade IIIa). Two patients developed transient stress urinary incontinence requiring medication (Grade II). One patient experienced urethral stricture managed with urethral dilation (Grade IIIa), and one developed bladder neck contracture necessitating resection (Grade IIIb). No Grade IV or V complications were observed in either group.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this three-year retrospective study, laser-driven non-lifting anatomical enucleation of the prostate using both holmium and thulium laser systems demonstrated favorable safety and efficacy outcomes in a day-case setting. The non-lifting approach, characterized by the use of precise laser incision and vaporization rather than blunt mechanical dissection for adenoma removal, allowed for controlled tissue separation with optimal preservation of the apical prostatic tissue and urethral sphincter complex. This technique likely contributed to reduced traction-related trauma, minimized intraoperative bleeding, and earlier recovery of urinary continence, consistent with previously reported findings\u003csup\u003e[7,9]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOver the study period, the non-lifting anatomical enucleation technique was successfully applied in 127 consecutive day-case procedures. A high proportion of patients (85%) were discharged within 24 hours (91% in HoLEP and 78% in ThuLEP), and more than 95% within 48 hours, underscoring the feasibility of same-day discharge for appropriately selected patients. The overall perioperative complication rate was 11.8%, with no Clavien–Dindo Grade IV or V events, and no patient required blood transfusion or reoperation for hemostasis. These results indicated that both HoLEP and ThuLEP performed with the non-lifting anatomical enucleation technique were safe and effective for day-case management, yielding high early discharge rates and favorable complication profiles. The outcomes observed in our series are comparable to, or even surpass, those reported in previous studies, where same-day discharge rates ranged from 70% to 87% and readmission or complication rates varied between 0% and 17.8%\u003csup\u003e[11,12]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough both holmium and thulium laser systems achieved comparable postoperative functional improvements in this study, several technical distinctions might explain the subtle differences in operative performance. The thulium laser, characterized by continuous-wave emission and superior coagulation, tended to produce a broader eschar zone along the resection plane, which could occasionally obscure the prostatic capsule and lead to minor loss of the enucleation layer\u003csup\u003e[13,14]\u003c/sup\u003e. This effect might account for the smaller amount of resected tissue observed in the ThuLEP group compared with the HoLEP group, suggesting a potential risk of incomplete adenoma removal. In addition, the higher vaporization efficiency of the thulium laser likely contributed to the reduced specimen weight, as part of the prostatic tissue was vaporized during enucleation. In some cases, limited blunt manipulation was required to re-establish the correct anatomical plane during ThuLEP. These findings aligned with previous studies reporting that HoLEP and ThuLEP yield similar long-term symptom and flow improvements, while small variations in operative efficiency were likely attributable to differences in laser–tissue interaction rather than surgical technique\u003csup\u003e[15,16]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eRegarding early postoperative recovery, the HoLEP group showed a higher proportion of patients discharged and catheter-free within 24 hours, though the difference was not statistically significant. The earlier establishment of HoLEP at our center could have contributed to smoother perioperative management compared with ThuLEP program. Despite comparable intraoperative blood loss between the two groups, mild hematuria on the first postoperative day occurred more frequently after ThuLEP. This phenomenon was likely related to minor tissue residuals and occasional mechanical manipulation during capsule localization, rather than to any intrinsic limitation in the hemostatic capability of the thulium laser. Similar findings had been reported in prior studies, where transient hematuria occurred slightly more often after ThuLEP despite equivalent catheterization times and bleeding control\u003csup\u003e[17,18]\u003c/sup\u003e. Collectively, these results suggested that while both laser systems were safe and effective for day-case prostate enucleation, HoLEP might offered marginal advantages in operative efficiency and early recovery, particularly during the initial adoption phase of ThuLEP.\u003c/p\u003e\n\u003cp\u003eRecent studies had reported that early catheter removal after endoscopic enucleation of the prostate—particularly when using anatomical or non-lifting techniques—achieves success rates of 85–94%, with urinary retention rates as low as 3–8%, and minor hematuria being the most common transient event\u003csup\u003e[11,19,20]\u003c/sup\u003e. However, there remained no standardized definition regarding the optimal duration of postoperative catheterization. In our cohort of 127 patients, catheter removal was attempted once the urine remained clear for 6–8 consecutive hours. Overall, 67.7% of patients successfully underwent catheter removal on postoperative day one (71.6% in the HoLEP group and 63.3% in the ThuLEP group, respectively). Three patients required re-catheterization—two due to transient urinary retention, managed with a temporary 16Fr Foley catheter, and one due to persistent gross hematuria who remained hospitalized for observation. For patients whose urine remained mildly blood-tinged but without fresh clots on postoperative day one, we adopted a “home-catheterization” approach, allowing discharge with the catheter in situ and daily online follow-up assessments. This strategy was proven safe and effective in maintaining patient comfort, minimizing unnecessary hospitalization, and optimizing resource utilization, consistent with previous reports supporting outpatient catheter management after laser prostate enucleation\u003csup\u003e[21,22]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePostoperative complication rates in both the HoLEP and ThuLEP groups were low and mostly mild, which aligned well with findings from previous meta-analyses and systematic reviews\u003csup\u003e[11]\u003c/sup\u003e. Reported rates of transfusion-requiring bleeding and major hemorrhagic events were below 3–5%, urinary retention necessitating re-catheterization occurred in 3–8% of cases, transient urinary incontinence in 5–10%, urinary tract infections in 2–6%, and urethral or bladder neck strictures in less than 2%. In our cohort, the overall complication spectrum was comparable, and no statistically significant differences were observed between the two procedures. Among the two patients who required re-catheterization for postoperative urinary retention, one had preoperative AUR, likely leading to incomplete detrusor recovery\u003csup\u003e[23]\u003c/sup\u003e, whereas the other had a relatively small prostate (31 ml) and experienced transient obstruction secondary to localized postoperative edema\u003csup\u003e[24,25]\u003c/sup\u003e. Consistent with prior reports, these observations suggest that a slightly prolonged catheterization period in selected patients—particularly those with preoperative AUR or small prostate volumes—may help lower the risk of recurrent retention and related complications.\u003c/p\u003e\n\u003cp\u003ePostoperative urinary incontinence represented another important consideration. In our cohort, two patients in the ThuLEP group experienced transient stress urinary incontinence, which was likely related to early-stage learning curve factors, including slight mechanical manipulation during capsule dissection and longer operative times. Both cases were managed conservatively with pharmacologic therapy (duloxetine), and continence fully recovered within three months. Previous studies have reported similar incidences of transient urinary incontinence following laser enucleation procedures, particularly during the initial adoption phase, and emphasized that conservative management—including observation, pelvic floor exercises, and, when indicated, pharmacotherapy—usually leads to full recovery without the need for surgical intervention\u003csup\u003e[26]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study had several limitations. First, it was a single-center retrospective analysis evaluating the safety and efficacy of the non-lifting laser enucleation technique in day-case management of BPH using different laser modalities. Therefore, potential selection and recall biases could not be fully eliminated. Multicenter, prospective, and randomized comparative studies were warranted to further validate our findings and establish stronger evidence for the generalizability of this technique. Second, to ensure perioperative safety, only patients with relatively good overall health and limited comorbidities were selected for the day-case procedure in our outpatient pre-admission system. Consequently, the applicability, safety, and outcomes of this technique in higher-risk populations—such as those with significant cardiovascular disease, ongoing anticoagulant therapy, or impaired renal function—remain uncertain. Future research should therefore include a broader spectrum of patients and incorporate standardized preoperative risk assessment models to refine selection criteria for day-case endoscopic enucleation. Additionally, the study lacked long-term functional follow-up and detailed cost-effectiveness analysis, which may further elucidate the advantages of this minimally invasive, same-day approach.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe non-lifting laser enucleation technique represented an innovative refinement of anatomical endoscopic prostate surgery, emphasizing precise capsule-based dissection without mechanical traction. In our experience, this approach demonstrated excellent safety, hemostatic control, and early recovery profiles within a day-case setting using both holmium and thulium laser systems. These findings supported its feasibility and short-term efficacy; however, further multicenter, prospective research with extended follow-up and inclusion of higher-risk patient populations was required to confirm its long-term safety, durability, and cost-effectiveness. Continued optimization of perioperative assessment and patient selection criteria remained essential to fully realize the advantages of this minimally invasive, same-day surgical approach for BPH.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBPH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBenign Prostatic Hyperplasia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTURP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransurethral Resection of Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHoLEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHolmium Laser Enucleation of Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eThuLEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThulium Laser Enucleation of Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProstate-Specific Antigen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute urinary retention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-Voiding Residue\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Prostate Symptom Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQmax\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMaximum urinary flow rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWZ Liu: Data analysis, Manuscript writing and editing;\u003c/p\u003e\n\u003cp\u003eAQ Shao: Data collection and analysis;\u003c/p\u003e\n\u003cp\u003eBB Yang: Data collection and management;\u003c/p\u003e\n\u003cp\u003eZJ Yan: Revision of manuscript;\u003c/p\u003e\n\u003cp\u003eJH Qian: Protocol, project development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study (involving humans) was performed in accordance with the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of the First Affiliated Hospital of NingBo University. Informed consent to participate in the study was obtained from all the subjects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analysed during the current study are not publicly available due to an agreement with the subjects but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eThe authors gratefully acknowledge the contributions of the clinical and nursing teams from the Department of Urology, the First Affiliated Hospital of Ningbo University, for their support in data acquisition and patient management. The authors also thank the hospital\u0026rsquo;s clinical research center for its assistance in data analysis and coordination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Information: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Ningbo Clinical Research Center for Urological Disease, No.2019A21001;\u003c/p\u003e\n\u003cp\u003e2. Ningbo Top Medical and Health Research Program, No.2022020203;\u003c/p\u003e\n\u003cp\u003e3. Zhejiang Engineering Research Center of Innovative technologies and diagnostic and therapeutic equipment for urinary system diseases.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDiana P, Baboudjian M, Saita A, et al. Same-day discharge for endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol. 2023 Aug;41(8):2099-2106. doi: 10.1007/s00345-023-04471-3. Epub 2023 Jul 3. PMID: 37395755.\u003c/li\u003e\n\u003cli\u003eCooley LF, Assmus M, Ganesh M, et al. Predictors of Failed Same-Day Catheter Removal After Holmium Laser Enucleation of the Prostate. Urology. 2022 Dec;170:168-173. doi: 10.1016/j.urology.2022.07.047. Epub 2022 Aug 10. PMID: 35963396.\u003c/li\u003e\n\u003cli\u003ePerri D, Pacchetti A, Morini E, et al. Prognostic Factors Predicting Bleeding After Discharge Requiring Readmission After Thulium Laser Enucleation of the Prostate (ThuLEP). Soci\u0026eacute;t\u0026eacute; Internationale d\u0026rsquo;Urologie Journal. 2023; 4(5):385-391. https://doi.org/10.48083/LXOI8745.\u003c/li\u003e\n\u003cli\u003eZhao X, Jia L, Li W, et al. Safety and efficacy of low-powered holmium laser enucleation of the prostate in comparison with plasma kinetic resection of prostate. Lasers Med Sci. 2024 Dec 28;40(1):2. doi: 10.1007/s10103-024-04261-2. PMID: 39731626.\u003c/li\u003e\n\u003cli\u003eDinkar Mahajan A, Rajendra Sharma A, G Patil M. Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique-A Prospective Randomized Study. Urol Res Pract. 2024 Jan;50(1):47-52. doi: 10.5152/tud.2024.23177. PMID: 38451130; PMCID: PMC11059977.\u003c/li\u003e\n\u003cli\u003eCochetti G, Del Zingaro M, Panciarola M, et al. Safety and Efficacy of a Modified Technique of Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia. Applied Sciences. 2021; 11(6):2467. https://doi.org/10.3390/app11062467.\u003c/li\u003e\n\u003cli\u003eEricson CA, Baird BA, Mauler DJ, et al. Early apical release versus En-bloc no touch technique for holmium laser enucleation of the prostate: a high-volume single-surgeon cohort study. World J Urol. 2023 Jan;41(1):167-172. doi: 10.1007/s00345-022-04206-w. Epub 2022 Nov 10. PMID: 36357603.\u003c/li\u003e\n\u003cli\u003eLin CH, Wu WJ, Li CC, et al. Preoperative predictors of enucleation time during en bloc \u0026apos;no-touch\u0026apos; holmium laser enucleation of the prostate. BMC Urol. 2020 Nov 11;20(1):185. doi: 10.1186/s12894-020-00758-4. PMID: 33176769; PMCID: PMC7661272.\u003c/li\u003e\n\u003cli\u003eBozzini G .Prognostic Factors Predicting Bleeding After Discharge Requiring Readmission After Thulium Laser Enucleation of the Prostate (ThuLEP)[J].Soci\u0026eacute;t\u0026eacute; Internationale d\u0026rsquo;Urologie Journal, 2023, 4.DOI:10.48083/LXOI8745.\u003c/li\u003e\n\u003cli\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae.\u003c/li\u003e\n\u003cli\u003eSpinos T, Tatanis V, Liatsikos E, et al. Same-day catheter removal after holmium laser enucleation of the prostate (HoLEP): a systematic review. World J Urol. 2023 Dec;41(12):3503-3510. doi: 10.1007/s00345-023-04655-x. Epub 2023 Oct 25. PMID: 37878061.\u003c/li\u003e\n\u003cli\u003eBadreddine J, Sun H, Tay K, et al. The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic. World J Urol. 2023 Jun;41(6):1613-1619. doi: 10.1007/s00345-023-04410-2. Epub 2023 May 9. PMID: 37160451; PMCID: PMC10169120.\u003c/li\u003e\n\u003cli\u003eAybal HC, Yilmaz M, Barlas IS, et al. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol. 2024 Jun 13;42(1):374. doi: 10.1007/s00345-024-05082-2. PMID: 38871959.\u003c/li\u003e\n\u003cli\u003eKaya E, Yılmaz S, A\u0026ccedil;ıkg\u0026ouml;z O, et al. Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia. 2021 Sep;53(8):e14125. doi: 10.1111/and.14125. Epub 2021 May 24. PMID: 34029399.\u003c/li\u003e\n\u003cli\u003eSun F, Yao H, Bao X, et al. The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis. Am J Mens Health. 2022 Jul-Aug;16(4):15579883221113203. doi: 10.1177/15579883221113203. PMID: 35864746; PMCID: PMC9310232.\u003c/li\u003e\n\u003cli\u003eChen YY, Hua WX, Huang YH, et al. The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis. BMC Urol. 2024 Jun 17;24(1):128. doi: 10.1186/s12894-024-01517-5. PMID: 38886739; PMCID: PMC11181543.\u003c/li\u003e\n\u003cli\u003eBozzini G, Berti L, Maltagliati M, et al. Current evidence of ThuLEP for BPH: A review of literature. Turk J Urol. 2021;47(6):461-469. doi:10.5152/tud.2021.21170.\u003c/li\u003e\n\u003cli\u003eWang J, Wu S, Wang M. Role of Thulium Laser and Holmium Laser in the Surgical Treatment of Benign Prostatic Hyperplasia: A Systemic Review and Meta-Analysis. Iran J Public Health. 2024;53(3):495-507. doi:10.18502/ijph.v53i3.15131.\u003c/li\u003e\n\u003cli\u003eLee SM, Gordon K, McMillan R, et al. Day-case holmium laser enucleation of the prostate: feasibility, safety and predictive factors. Ann R Coll Surg Engl. 2018 Jul;100(6):475-479. doi: 10.1308/rcsann.2018.0039. Epub 2018 Mar 15. PMID: 29543065; PMCID: PMC6111899.\u003c/li\u003e\n\u003cli\u003eSlade A, Agarwal D, Large T, et al. Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate. J Endourol. 2022 Jul;36(7):977-981. doi: 10.1089/end.2022.0007. Epub 2022 Jun 21. PMID: 35045752.\u003c/li\u003e\n\u003cli\u003eGordon TT, Gordon N. A 27-Year Experience With Day Surgery Transurethral Resection of the Prostate. Cureus. 2024;16(3):e55699. Published 2024 Mar 7. doi:10.7759/cureus.55699.\u003c/li\u003e\n\u003cli\u003eErazo JC, Suso-Palau D, Sejnaui JE, et al. Outpatient 180 W XPS GreenLight Laser Photoselective Vaporization of the Prostate: 7-Year Experience. J Endourol. 2022;36(4):548-553. doi:10.1089/end.2021.0618.\u003c/li\u003e\n\u003cli\u003eLee CL, Jhang JF, Ho HC, et al. Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification. Sci Rep. 2022 Jan 10;12(1):362. doi: 10.1038/s41598-021-04237-0. PMID: 35013465; PMCID: PMC8748740.\u003c/li\u003e\n\u003cli\u003eHsu YH, Hou CP, Weng SC, et al. Analysis of urinary retention after endoscopic prostate enucleation and its subsequent impact on surgical outcomes. World J Urol. 2024 May 9;42(1):305. doi: 10.1007/s00345-024-04918-1. PMID: 38724829.\u003c/li\u003e\n\u003cli\u003eChen YH, Li XD, Ke ZB, et al. Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia. Asian J Surg. 2023 Jan;46(1):373-379. doi: 10.1016/j.asjsur.2022.04.076. Epub 2022 May 4. PMID: 35525691.\u003c/li\u003e\n\u003cli\u003eLicari LC, Bologna E, Manfredi C, et al. Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis. Minerva Urol Nephrol. 2024;76(5):618-624. doi:10.23736/S2724-6051.24.05802-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eTable.1 Patients\u0026rsquo; Demographics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eHoLEP (n=67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eThuLEP (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eAge (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e68.3\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e67.9\u0026plusmn;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eVol of Prostate (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e59.8\u0026plusmn;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e60.3\u0026plusmn;13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=-0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePSA (ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4.0\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3.6\u0026plusmn;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePre-IPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e18.4\u0026plusmn;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e18.0\u0026plusmn;5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePre-QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePre-Qmax (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e7.0\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e6.8\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003et=0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eUrinary Retention(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e35 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e32 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ep=0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eTable.2 Overall Surgical outcomes for Non-lifting Laser Enucleation of Prostate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePost-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eIPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18.2\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e5.9\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003et=25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.2\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003et=26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eQmax (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.9\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e21.1\u0026plusmn;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003et=-30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eTable.3 Operative parameters and Surgical outcomes between two groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eHoLEP (n=67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eThuLEP (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eSurgical time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e43.5\u0026plusmn;17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e48.4\u0026plusmn;18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=-1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eCutting Tissue (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e48.2\u0026plusmn;13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e39.0\u0026plusmn;15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eDropping of Hb (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e12.7\u0026plusmn;14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e13.3\u0026plusmn;13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=-0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003ePost- IPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.8\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e5.9\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003ePost- QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1.3\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=-0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003ePost- Qmax (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e21.6\u0026plusmn;4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e20.5\u0026plusmn;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eImprovement of IPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e12.6\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e12.1\u0026plusmn;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eImprovement of QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3.4\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3.3\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eImprovement of Qmax (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e14.5\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e13.7\u0026plusmn;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003et=0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e24-hours discharge(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e61 (91.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e47 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e48-hours discharge(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e64 (95.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e57 (95.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1-day catheter(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e48 (71.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e38 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3-days catheter(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e66 (98.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e58 (96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 112px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003cp\u003e(Clavien\u0026ndash;Dindo)\u003c/p\u003e\n \u003cp\u003e(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e4 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 79px;\"\u003e\n \u003cp\u003ep=0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e2 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅢa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (5.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅢb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0 ( 0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eⅤ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"En-bloc, non-lifting laser enucleation, day-case surgery, benign prostatic hyperplasia","lastPublishedDoi":"10.21203/rs.3.rs-8659895/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8659895/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The study aimed to compare the efficacy, perioperative outcomes, and safety of en-bloc non-lifting anatomical laser enucleation using holmium (HoLEP) and thulium (ThuLEP) systems in a day-case setting, and to evaluate its feasibility for ambulatory management of benign prostatic hyperplasia (BPH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis was performed on 127 consecutive patients who underwent day-case en-bloc non-lifting laser enucleation for BPH from January 2022 to July 2025. Patients with prior prostate or urethral surgery, or ongoing antiplatelet therapy were excluded. Perioperative parameters, including operative time, enucleated tissue weight, hemoglobin reduction, catheterization time, and complications (classified by the Clavien–Dindo system), were recorded. Postoperative follow-up was conducted at 2, 6, and 12 weeks. Statistical analyses were performed using SPSS version 26.0, with p \u0026lt; 0.05 indicating significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e A total of 67 HoLEP and 60 ThuLEP procedures were performed using the en-bloc non-lifting anatomical technique. The two groups were comparable in baseline characteristics. Operative time and hemoglobin decrease were similar between groups, although the mean resected tissue weight was significantly greater in the HoLEP group (p \u0026lt; 0.01). Postoperative recovery was rapid, with 85.0% of patients discharged within 24 hours and 95.3% within 48 hours; catheter removal was achieved in 67.7% on postoperative day 1 and in 97.6% by day 3. The overall perioperative complication rate was 11.8%, with no severe adverse events, and no significant difference between the two laser systems (p \u0026gt; 0.05). Both procedures resulted in substantial functional improvement, as reflected by significant reductions in IPSS and QoL scores and a more than threefold increase in Qmax (all p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The en-bloc non-lifting anatomical laser enucleation technique offered a safe, efficient, and anatomically precise solution for day-case BPH surgery, achieving rapid recovery and comparable results with both holmium and thulium lasers.\u003c/p\u003e","manuscriptTitle":"Clinical outcomes of en-bloc non-lifting anatomical enucleation in day-case laser surgery for benign prostatic hyperplasia: a comparative study of HoLEP and ThuLEP","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 12:10:10","doi":"10.21203/rs.3.rs-8659895/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27e10a95-70aa-49de-a9ac-ea17e7f3ad4f","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T07:26:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 12:10:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8659895","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8659895","identity":"rs-8659895","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}