Effect of Laser Energy Consumption on Early-Stage LUTS after HoLEP: Comparison of Symptom Improvements between Low and High Energy Consumed Procedures

Effect of Laser Energy Consumption on Early-Stage LUTS after HoLEP: Comparison of Symptom Improvements between Low and High Energy Consumed Procedures | 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 Effect of Laser Energy Consumption on Early-Stage LUTS after HoLEP: Comparison of Symptom Improvements between Low and High Energy Consumed Procedures Ke Liu, Youlong Zong, Ruotao Xiao, Shiying Tang, Jianfei Ye, Lei Zhao, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5736945/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 Purpose To compare early-stage lower urinary tract symptoms following low and high energy consumed holmium laser enucleation of the prostate (HoLEP). Methods Eighty patients who underwent HoLEP at our hospital between May 2020 and December 2021 were retrospectively evaluated. All procedures were performed applying a single laser device with the same power settings. Patients were divided equally into two groups (low vs. high) according to total laser energy (TLE), L/P ratio (TLE/resected prostate weight), and laser rate (TLE/enucleation time), successively. The follow-up points included 1-week, 2-week, 3-week, 1-month, and 3-month, postoperatively. The International Prostate Symptom Score (IPSS) and the subscores of storage (IPSS-S) and voiding (IPSS-V) were assessed and compared between the two groups. Urinary incontinence and complications were also compared between the groups. Results The mean baseline IPSS, IPSS-S, and IPSS-V scores were comparable between the groups. The 1-week, 3-week, and 3-month IPSS-V in the low-TLE group were significantly higher than that in high-TLE group (5.23 ± 4.5vs3.15 ± 4.36, P = 0.034; 3.88 ± 3.53vs1.43 ± 1.97, P<0.001, 3.30 ± 4.68vs1.78 ± 3.22, P = 0.019, respectively). No significant differences between the groups were revealed when TLE was adjusted for enucleation weight (L/P ratio) or enucleation time (laser rate). There were also no significant differences between the groups regarding urinary incontinence and complications at each follow-up point. Conclusion Low and high energy consumption have similar effects on symptoms in the early stages after HoLEP. Higher laser energy does not result in more severe postoperative storage symptoms. benign prostatic hyperplasia enucleation laser energy lower urinary tract symptoms follow-up Figures Figure 1 Figure 2 Introduction Holmium laser enucleation of the prostate (HoLEP) has gained popularity for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), with long-term efficacy. It alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by sweeping the entire adenoma off the surgical capsule with a holmium laser and removing this prostatic tissue via morcellation. As a result, sustained improvements in urinary function, including urinary flow rate, residual urine, and symptom score, with a combined retreatment rate of 0.5% beyond 5–10 years for symptomatic residual or adenoma regrowth can be observed[ 1 , 2 ]. Although these functional outcomes are generally satisfactory, postoperative storage symptoms (PSS), including frequency, urgency, and some degree of subjective burning, are often reported after HoLEP treatments, which present in approximately 30–68% of patients and usually persists for one-to-three month period until they resolve spontaneously[ 3 , 4 ]. Despite self-limiting of such adverse events, they could be bothersome and significantly interfere with the patients’ daily activities, especially in the early stages after catheter removal[ 5 ]. Naspro et al. proposed that certain symptoms after HoLEP are probably caused by the high energy applied to the capsule during the procedure[ 3 ]. Furthermore, it was raised that the laser energy applied during the procedure might be beneficial with respect to hemostasis, but some patients could pay the price of PSSs[ 4 ]. Based on this theory, some urologists have suggested that the incidence of these complications might be decreased if shorter laser exposure or lower energy consumption of the prostatic capsule could be achieved through technical refinement[ 5 , 6 ]. However, there is a lack of evidence in the literature to prove this. The effects of laser energy consumption on PSS in the early stages after HoLEP still remain unclear. Therefore, this study aimed to compare serial changes in postoperative symptoms between low and high energy consumed HoLEP procedures, in terms of the total International Prostate Symptom Score (IPSS) and subscores. Materials and Methods Patients Eighty patients underwent HoLEP for LUTS/BPH at our hospital between May 2020 and December 2021, were included in this study. The 3-month follow-up data of all patients were available in our HoLEP: Epidemiology, Technique, and Follow-up (HETF) database. Patients who did not complete the follow-up protocol were excluded from the study. The clinical data were retrospectively reviewed with the approval of the Institutional Review Board of our hospital. Baseline data included age, body mass index (BMI), prostate specific antigen (PSA), prostatic volume (PV), post-void residual urine volume (PVR), catheter dependency, preoperative IPSS and Quality of Life (QoL). Moreover, perioperative data including total laser energy (TLE) applied, enucleation time (ET), morcellation time (MT), prostate tissue removed (PTR), postoperative catheter duration, and surgery-related complications were evaluated. Surgical intervention and follow-up All procedures were performed by a fellowship-trained experienced surgeon (KL) using a 26-Fr continuous-flow laser resectoscope with a 30° lens (STORZ®) and a tissue morcellator (Wolf Piranha® or Hawk®). A 90-Watt holmium laser device (Sphinx®, LISA) was applied with adjustment of 2.0 J, 30 Hz, pulse width 300µs for the entire procedure of each individual patient in this study. Patients were followed up at 1, 2, and 3 weeks and then 1 and 3 months postoperatively. Symptom improvements after HoLEP were assessed with IPSS or IPSS + QoL at each follow-up and prospectively recorded in the HETF database. Because of traveling difficulty due to the Covid-19 pandemic, all patients in this study fulfilled their follow-up via a mobile application, which could send questionnaires automatically at each follow-up point. Grouping The low energy consumed (LEC) procedures were separated from high energy consumed (HEC) procedures by TLE applied during the procedure. Considering that PV and duration of the enucleation process have potential influences on laser exposure and TLE consumption, two variables described in previous literature were introduced to adjust TLE for PTR and ET, which were L/P ratio (TLE divided by the resected prostate weight in kJ/gm) and laser rate (TLE divided by the ET in kJ/min)[ 7 ]. Patients were divided into two groups (low versus high) according to mean TLE, median L/P ratio (L/P), and mean laser rate (Lr), successively. Baseline and perioperative data were compared between groups. Furthermore, the IPSS at each follow-up point, including the subtotal voiding (IPSS-V) and storage (IPSS-S) symptom scores as well as the frequency, urgency, and nocturia scores, were compared between the groups. Statistical analysis Descriptive statistics were reported in terms of numbers and percentages for categorical variables, means ± SD, or medians and quartiles, depending on data distribution for continuous variables. Baseline and follow-up continuous data were compared using an independent t-test for normal distribution and the Mann-Whitney U test for non-normal distribution. Chi-Square or Fisher exact test was used to compare categorical variables. Statistical significance was set at P < 0.05. Statistical Package for the Social Sciences (version 12.0) was used for the analysis. Results The mean TLE, median L/P, and mean Lr of the 80 evaluated patients were 163.65(range, 41.90 − 426.22) kJ, 4.56(range, 1.42–37.08) kJ/gm, and 1.98(range, 1.32–2.63) kJ/min, respectively. A summary of the periprocedural data is shown in Table 1 . There was a significantly lower mean TLE in the low-TLE group 109.94 ± 28.134 kJ than in the high-TLE group 217.36 ± 54.042 kJ, P < 0.001. The mean PV, median PSA, mean ET, median MT, median PTR, and mean enucleation efficiency (EE) in the low-TLE group were significantly lower than those in the high-TLE group, whereas the median L/P in the low-TLE group was significantly higher than that in the high-TLE group. There was a significantly lower median L/P in the low-L/P group 3.18(2.40,3.96) kJ/gm than in high-L/P group 7.19(4.97,10.54) kJ/gm, P<0.001. The mean age, mean PV, proportion of IPP, median MT, median PTR, and mean EE were significantly higher in the low-L/P group than in the high-L/P group. Moreover, there was a significantly lower mean Lr in the low-Lr group 1.74 ± 0.030 kJ/min than in high-Lr group 2.20 ± 0.026 kJ/min, P<0.001. (Table 1 ) Table 1 Comparison of baseline between the groups Total laser energy L/P ratio Laser rate Low High P value Low High P value Low High P value Age (y) 70.03 ± 8.027 72.15 ± 8.787 0.262 73.03 ± 8.201 69.15 ± 8.307 0.039 70.83 ± 9.591 71.35 ± 7.199 0.783 BMI 23.33 ± 2.778 23.92 ± 2.282 0.306 23.75 ± 2.843 23.49 ± 2.232 0.655 23.89 ± 2.600 23.36 ± 2.490 0.358 PV (ml) 51.17 ± 21.752 95.63 ± 42.688 <0.001 93.65 ± 41.774 53.14 ± 26.884 5mm) (n) 17 24 0.117 27 14 0.004 21 20 0.823 PSA (ng/ml) 2.61(1.37, 4.97) 5.85(3.59, 11.80) <0.001 4.20(2.94, 6.90) 3.16(1.49, 8.29) 0.233 4.12(2.40, 7.36) 3.55(1.75, 7.81) 0.644 PVR^ (ml) 39.05(5.73, 120.50) 47.5(10,140.3) 0.582 36.05(9.7, 107) 47(10, 155) 0.438 38(7.15,149.25) 42.9(9.9, 113.75) 0.850 Catheter dependency (n) 10 16 0.152 13 13 1.000 13 13 1.000 Enucleation time (min) 58.45 ± 16.702 107.03 ± 22.229 <0.001 88.58 ± 26.605 76.90 ± 34.719 0.095 84.60 ± 29.141 80.88 ± 33.568 0.598 Morcellation time (min) 5.5(3, 9) 12(7.5, 18.75) <0.001 12(8.25,21.5) 5(3, 9) <0.001 9(5.25, 14.5) 8.5(4.25, 16.25) 0.671 Resected prostate weight (gm) 23.57(9.93, 32.56) 53.41(37.75, 84.69) <0.001 56.51(34.01, 81.43) 23.03(9.93, 35.27) <0.001 35.40(22.93, 59.19) 33.47(19.2, 62.39) 0.900 Enucleation efficiency (gm/min) 0.37 ± 0.210 0.60 ± 0.310 <0.001 0.69 ± 0.259 0.28 ± 0.122 <0.001 0.45 ± 0.235 0.52 ± 0.332 0.283 Total laser energy (kJ) 109.94 ± 28.134 217.36 ± 54.042 <0.001 176.26 ± 61.794 151.04 ± 74.060 0.102 148.36 ± 53.290 178.94 ± 79.438 0.47 L/P ratio (kJ/gm) 5.37(3.77, 9.83) 4.18(2.48, 4.92) 0.002 3.18(2.40, 3.96) 7.19(4.97, 10.54) <0.001 4.33(3.13, 6.86) 4.64(3.61, 8.18) 0.303 Laser rate (kJ/min) 1.92 ± 0.315 2.04 ± 0.259 0.061 1.98 ± 0.045 1.96 ± 0.047 0.792 1.74 ± 0.030 2.20 ± 0.026 <0.001 Catheter duration (d) 2(2, 2) 2(2 ,2) 0.877 2(2, 2) 2(2, 2) 0.443 2(2, 2) 2(2, 2) 0.085 *Intravesical prostatic protrusion ^Post-void residual The mean baseline IPSS, IPSS-S, and IPSS-V scores were comparable between the groups. However, the 1-week and 3-week postoperative IPSS-V in the low-TLE group were significantly higher than in high-TLE group (5.23 ± 4.52 versus 3.15 ± 4.36, P = 0.034; 3.88 ± 3.53 versus 1.43 ± 1.97, P<0.001, respectively). Similarly, the 3-month postoperative IPSS-V in the low-TLE group was significantly higher than in high-TLE group (3.30 ± 4.68 versus 1.78 ± 3.22, P = 0.019). (Table 2 , Fig. 1 ) Furthermore, the only significant difference of storage symptom was the urgency scores between the high-TLE group and low-TLE group at 1 month follow-up, which was 1(0,2) versus 1(0,1) (P = 0.042). (Supplementary Table 1, Fig. 2 ) Table 2 Comparison of functional outcomes between the groups Total laser energy L/P ratio Laser rate Low High P value Low High P value Low High P value Baseline IPSS 19.58 ± 8.23 19.25 ± 8.08 0.772 18.78 ± 7.39 20.05 ± 8.81 0.485 19.85 ± 7.91 18.98 ± 8.37 0.632 IPSS-S 8.78 ± 4.17 8.98 ± 3.52 0.555 8.30 ± 2.89 9.45 ± 4.55 0.182 8.28 ± 3.42 9.48 ± 4.16 0.163 IPSS-V 12.05 ± 5.30 11.23 ± 5.50 0.396 10.48 ± 5.51 12.80 ± 5.05 0.53 11.68 ± 5.53 11.60 ± 5.30 0.951 QoL 4.23 ± 1.44 4.48 ± 1.04 0.663 4.38 ± 0.98 4.33 ± 1.49 0.787 4.15 ± 1.33 4.55 ± 1.15 0.207 1-week follow up IPSS 12.59 ± 7.27 10.25 ± 6.29 0.135 11.00 ± 6.75 11.80 ± 7.01 0.582 11.69 ± 6.85 11.13 ± 6.92 0.648 IPSS-S 7.36 ± 3.71 7.15 ± 3.62 0.902 7.05 ± 3.47 7.45 ± 3.84 0.665 6.77 ± 3.54 7.73 ± 3.73 0.251 IPSS-V 5.23 ± 4.52 3.15 ± 4.36 0.034 3.95 ± 4.47 4.40 ± 4.63 0.721 4.97 ± 4.77 3.40 ± 4.20 0.137 2-week follow up IPSS 9.80 ± 6.14 9.13 ± 5.16 0.596 9.38 ± 5.38 9.55 ± 5.97 0.891 9.60 ± 5.14 9.33 ± 6.18 0.829 IPSS-S 6.05 ± 3.09 6.80 ± 3.72 0.414 6.55 ± 3.20 6.30 ± 3.65 0.639 6.08 ± 2.98 6.78 ± 3.81 0.496 IPSS-V 3.75 ± 3.89 2.32 ± 2.58 0.145 2.83 ± 3.34 3.25 ± 3.39 0.627 3.53 ± 3.57 2.55 ± 3.09 0.181 3-week follow up IPSS 9.75 ± 5.55 7.85 ± 4.23 0.123 8.45 ± 4.85 9.15 ± 5.18 0.540 8.70 ± 5.16 8.90 ± 4.90 0.725 IPSS-S 5.87 ± 2.97 6.43 ± 3.15 0.588 6.23 ± 2.90 6.08 ± 3.24 0.702 5.85 ± 3.03 6.45 ± 3.09 0.272 IPSS-V 3.88 ± 3.53 1.43 ± 1.97 <0.001 2.23 ± 3.08 3.08 ± 3.09 0.166 2.85 ± 3.32 2.45 ± 2.89 0.626 1-month follow up IPSS 10.05 ± 6.38 8.13 ± 4.90 0.196 9.65 ± 5.77 8.46 ± 5.68 0.302 9.90 ± 6.08 8.19 ± 5.25 0.160 IPSS-S 6.42 ± 3.24 5.90 ± 3.14 0.483 6.65 ± 3.25 5.62 ± 3.06 0.151 6.30 ± 3.20 6.00 ± 3.20 0.727 IPSS-V 3.63 ± 4.19 2.23 ± 3.05 0.068 2.90 ± 3.68 2.95 ± 3.77 0.904 3.50 ± 4.30 2.30 ± 2.84 0.218 QoL 2.92 ± 1.58 2.41 ± 1.50 0.147 2.90 ± 1.63 2.41 ± 1.44 0.187 2.90 ± 1.57 2.41 ± 1.52 0.151 3-month follow up IPSS 8.32 ± 6.63 5.97 ± 5.01 0.053 7.47 ± 6.20 6.81 ± 5.75 0.529 7.16 ± 6.52 7.14 ± 5.38 0.790 IPSS-S 5.03 ± 2.85 4.19 ± 2.88 0.170 5.11 ± 3.13 4.08 ± 2.51 0.156 4.45 ± 2.82 4.78 ± 2.97 0.760 IPSS-V 3.30 ± 4.68 1.78 ± 3.22 0.019 2.37 ± 3.94 2.72 ± 4.23 0.695 2.71 ± 4.72 2.36 ± 3.29 0.785 QoL 2.43 ± 1.42 1.76 ± 1.32 0.074 2.34 ± 1.53 1.83 ± 1.23 0.145 2.21 ± 1.54 1.97 ± 1.25 0.579 The incidence of urinary incontinence at 1-month, 3-month and 6-month follow-ups was 22.5%, 10.0%, and 6.3%, respectively. All of them were self-relieved within one year after surgery. There were complications observed in this cohort including 3 dysuria after removal of the catheter needed re-catheterization (Clavien Ⅰ), 3 bulbar strictures (Clavien Ⅲa) and one urethral meatus stenosis (Clavien Ⅲa) cured by regular urethrotomy. Other surgery-related complications included one superficial bladder mucosa injury during morcellation (Clavien I) prolonging the catheter indwelling, and one long-term postoperative hemorrhage requiring bladder irrigation in the E.R.. (Clavien Ⅱ). There were no significant differences between groups regarding incidence of postoperative urinary incontinence and complications. (Supplementary Table 2) Discussion HoLEP has been currently accepted as the first line surgical option for the management of symptoms secondary to BPH. Several large cohort studies have been published with excellent outcomes regarding the long-term improvement of LUTS and sustained reduction of IPSS more than one year postoperatively[ 8 , 9 ]. However, it is not uncommon for patients to experience persistent or even aggravated storage symptoms in the early postoperative period. Although most of them are limited duration and self-relieved, the irritative bladder will in particular adversely affect quality of life and interfere with the patients’ daily activities[ 5 ]. In recent years, controversial discussions regarding low-power HoLEP have been evolved focusing on its technical feasibility, equal efficiency and, more importantly, the potential advantages compared with high-power HoLEP, such as mild irritative symptoms in the convalescence period and less impact on the urinary sphincter. There were two high quality randomized trial compared low-power with high-power HoLEP procedures regarding functional outcomes[ 7 , 10 ]. Unexpectedly, no significant differences between the groups were revealed with regard to IPSS at each follow-up point, which challenges the concept that lower laser energy will reduce PSSs. Notably, none of the aforementioned studies reported TLE during the procedure. Therefore, it is uncertain whether the application of a high-power laser is associated with a more energy consumed procedure. Furthermore, Elshal et al. reported that the median laser energy applied in relation to the enucleation weight did not significantly differ between low-power and high-power procedures, which confused the relationship between the laser device and energy consumption[ 7 ]. Interestingly, the present study revealed that similar to TLE, the L/P ratio also depends on the PV. However, a prostate with a smaller volume is associated with a lower TLE, but a higher L/P ratio. A possible explanation for this finding might be that more energy is needed when accessing the capsule or dissecting the gland due to the relative indistinct or adhesive surgical plane of the smaller prostate. Recently, Westhofen et al. first assessed the impact of TLE on short-term functional outcomes after HoLEP and reported that there was no significant correlation between TLE and postoperative IPSS[ 11 ]. In line with this result, the present study confirmed that both low-TLE and high-TLE groups had comparable storage symptoms and total IPSS. Furthermore, similar results were observed despite adjustment of TLE for enucleation weight or ET. The only significant difference appeared in the improvement of voiding symptom between the high-TLE and low-TLE groups. The greater change in IPSS-V in the high-TLE group can be attributed to the remarkable relief from urethral resistance due to the greater amount of tissue retrieved, depending on the prostatic volume. As mentioned above, there have been many scientific evidences of the long-term relief of LUTS after HoLEP. However, rare data in previous literatures focused on the early-stage improvement of symptoms. A randomized trial comparing functional outcomes of HoLEP versus TURP noted that the patients didn’t achieve a remarkable reduction of the symptom score after HoLEP compared with TURP at the 1-month follow-up[ 12 ]. Unfortunately, there was only 1-month or even 3-month data in the previous literatures regarding the comparison of low-power and high-power procedures. Thus, the effects of holmium laser on the status of patients within one month after catheter removal are still unclear. Fayad et al. reported a steep drop of IPSS from one week to 2-week time point after HoLEP[ 13 ]. Therefore, the relatively postponed follow-up might lose some important information about symptoms at a very early postoperative stage. To compensate for this deficiency in previous studies, we set the first follow-up point at one week after surgery, when the most severe post-HoLEP symptoms were presented. However, we failed to demonstrate significant differences between the LEC and HEC groups within one month. A holmium laser pulse can generate plasma bubbles between the tip of the fiber and the target tissue. In an in vitro study, Cecchetti et al. reported that when the holmium laser was set to 1.5 J and 20 Hz, the temperature at 2 mm from the tip of the fiber was 750°C, while the temperature at 0.5 mm laterally from the edge of the fiber was 350°C[ 14 ]. In addition to producing pressure waves for adenoma dissection, the expansion and collapse of the hot water vapor bubble also coincidentally deliver coagulating effects for hemostasis. In fact, the "whitening effect”, which refers to the blanching of capsule tissue, is observed during the enucleation process. This confirmed that hemostasis takes place during the entire procedure to preserve optimal vision because of the unique characteristics of the holmium laser[ 5 , 15 ]. However, the extensive coagulation zone and remaining necrotic tissue due to the effect of heat on the capsule may negatively impact symptom improvement in the initial postoperative period[ 16 , 17 ]. Considering that the tissue thickness at which 90% of the energy is absorbed is a constant value known as the penetration depth, the severity of this heat injury solely depends on the laser wavelength and is not affected by the power output of the laser[ 18 ]. This is a possible reason why it failed to demonstrate a correlation between postoperative symptom score and laser energy consumption. The results reported herein should be considered in light of some limitations. The retrospective nature and small sample size may have resulted in a selection bias. The insufficient sample size limited us to apply statistical measurements, such as propensity score matching analysis, to prevent this. However, there were no significant differences between the groups regarding baseline symptom scores. Therefore, valid conclusions could be drawn based on this cohort. Moreover, the lack of preoperative urodynamic data may also influence our estimates. Some conditions, including non-neurogenic overactive or low compliance bladder, were not excluded from the cohort, which may negatively affect the early improvement of storage symptoms and probably impact the conclusions. Further prospective studies with larger cohorts are needed to confirm our findings. Conclusions Low and high energy consumption have similar effects on symptom improvement after HoLEP. Higher laser energy does not result in more severe postoperative storage symptoms in the early stage following the procedure. Further research can be built on this foundation to reveal the true differences in functional outcomes between low-power and high-power HoLEP. Declarations The authors have no competing interests to declare that are relevant to the content of this article. No funding was received for conducting this study. Authors’ Contributions K Liu: conceptualization, data curation, formal analysis and writing–review & editing. Y Zong: data curation and writing–original draft. R Xiao: data curation. S Tang: data curation. J Ye: writing–review. L Zhao: supervision. C Xiao: supervision. S Zhang: resources. Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Ethics approval The study was approved by our institutional ethics committee. 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World J Urol 39(8):3005–3011. https://doi:10.1007/s00345-020-03535-y Westhofen T, Buchner A, Eismann L, Rodler S, Keller P, Atzler M, Jokisch F, Waidelich R, Becker A, Stief CG, Weinhold P (2023) The Impact of Laser Energy on Functional Outcome Following Holmium Laser Enucleation of the Prostate. Urology 182:190–195. https://doi:10.1016/j.urology.2023.08.020 Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR (2006) A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 50(3):569–573. https://doi:10.1016/j.eururo.2006.04.002 Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which choose? J Endourol 25(8):1347–1352. https://doi:10.1089/end.2011.0059 Cecchetti W, Zattoni F, Nigro F, Tasca A (2004) Plasma bubble formation induced by holmium laser: an in vitro study. Urology 63(3):586–590. https://doi:10.1016/j.urology.2003.09.010 El-Hakim A, Elhilali MM (2002) Holmium laser enucleation of the prostate can be taught: the first learning experience. BJU Int 90(9):863–869. https://doi:10.1046/j.1464-410x.2002.03071.x Hermanns T, Sulser T, Fatzer M, Baumgartner MK, Rey JM, Sigrist MW, Seifert HH (2009) Laser fire deterioration and loss of power output during photo-selective 80-w potassium-titanylphosphate laser vaporization of the prostate. Eur Urol 55(3):679–685. https://doi:10.1016/j.eururo.2008.03.035 Cho MC, Ha SB, Oh S-J, Kim SW, Paick J-S (2015) Change in storage symptoms following laser prostatectomy: comparison between photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). World J Urol 33(8):1173–1180. https://doi:10.1007/s00345-014-1424-0 Emiliani E, Talso M, Haddad M, Pouliquen C, Derman J, Côté JF, Doizi S, Millán F, Berthe L, Audouin M, Traxer O (2018) The True Ablation Effect of Holmium YAG Laser on Soft Tissue. J Endourol 32(3):230–235. https://doi:10.1089/end.2017.0835 Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.doc SupplementaryTable2.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5736945","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396229214,"identity":"1a223617-63eb-40bd-8025-5ac12cec7451","order_by":0,"name":"Ke Liu","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Liu","suffix":""},{"id":396229217,"identity":"5fca2866-93db-4577-8df6-18c460a162c0","order_by":1,"name":"Youlong Zong","email":"","orcid":"","institution":"Yan'an Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Youlong","middleName":"","lastName":"Zong","suffix":""},{"id":396229218,"identity":"698e1b09-6d06-453a-8aa4-afaf2d8f85a8","order_by":2,"name":"Ruotao Xiao","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ruotao","middleName":"","lastName":"Xiao","suffix":""},{"id":396229219,"identity":"39e1f8df-57c3-48db-ba95-928ba9aad398","order_by":3,"name":"Shiying Tang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shiying","middleName":"","lastName":"Tang","suffix":""},{"id":396229221,"identity":"7ddcd5c4-941a-4cf0-94ce-de20a8f81b67","order_by":4,"name":"Jianfei Ye","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianfei","middleName":"","lastName":"Ye","suffix":""},{"id":396229222,"identity":"9186ebe0-8488-47d7-96b2-79a203194f85","order_by":5,"name":"Lei Zhao","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Zhao","suffix":""},{"id":396229223,"identity":"3f357551-6371-4057-aa3c-88bcd4b9193a","order_by":6,"name":"Chunlei Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYDACZiBmbGBg4AOTBTYMbERrYQOTBmlEaGGAawEBg8OEVRscZ3744OeOw3ls7M1tEj8MztvzSTc/YPi5A7cWyWY2Y8PeM4eL2XgONhv2GNxObJM5ZsDYewa3Fn5mBjNpxrbDiW0SiY2PGQxuJ7BJJBgwM7bh1sLGzP4NokX+YcNhBoNz9mwS6R/wauFn5oHZwgiy5QBjm0QOflskm3mKDXvb0hPbeBJBfkkG6s0pONiLR4vB+eMbH/xss07sZz/+TOJHhZ29/Ix0kAhuLdjBAVI1jIJRMApGwShABQBq90omcpZuBQAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chunlei","middleName":"","lastName":"Xiao","suffix":""},{"id":396229226,"identity":"25744132-8d45-49eb-b0dd-f35dd9e57c5b","order_by":7,"name":"Shudong Zhang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shudong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-12-30 16:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5736945/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5736945/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72799191,"identity":"9802159c-9fb1-410f-b63d-c592b30d8019","added_by":"auto","created_at":"2025-01-02 09:22:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59404,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of changes in IPSS scores and subscores at different follow-up points between the groups divided by total energy (TE) (A-C), L/P ratio (L/P) (D-F), and laser rate (Lr) (G-I)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5736945/v1/0b1a857845a5bab0d1805878.png"},{"id":72800933,"identity":"32d683f3-e289-4c00-b7c6-0a2e3c0219f0","added_by":"auto","created_at":"2025-01-02 09:30:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27230,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of changes in storage symptom scores at different follow-up points within one month postoperatively between the groups divided by total energy (TE) (A-C), L/P ratio (L/P) (D-F), and laser rate (Lr) (G-I)\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5736945/v1/feb3ca2e9b245ae3b53dba8a.png"},{"id":73071966,"identity":"837128c8-1f67-42ee-81ae-4bf36c2d7ca9","added_by":"auto","created_at":"2025-01-06 12:44:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":675150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5736945/v1/c1855949-ba07-48ec-916f-7459206481ad.pdf"},{"id":72798753,"identity":"8bd2a55e-d501-44d2-b7a1-e63207886604","added_by":"auto","created_at":"2025-01-02 09:14:04","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45056,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.doc","url":"https://assets-eu.researchsquare.com/files/rs-5736945/v1/11b4c06b05a421687e3b3610.doc"},{"id":72796587,"identity":"86a7a364-4466-4557-aa44-d69161893d42","added_by":"auto","created_at":"2025-01-02 09:06:04","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27648,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable2.doc","url":"https://assets-eu.researchsquare.com/files/rs-5736945/v1/41237875273ec80fa5c96755.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Laser Energy Consumption on Early-Stage LUTS after HoLEP: Comparison of Symptom Improvements between Low and High Energy Consumed Procedures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHolmium laser enucleation of the prostate (HoLEP) has gained popularity for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), with long-term efficacy. It alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by sweeping the entire adenoma off the surgical capsule with a holmium laser and removing this prostatic tissue via morcellation. As a result, sustained improvements in urinary function, including urinary flow rate, residual urine, and symptom score, with a combined retreatment rate of 0.5% beyond 5\u0026ndash;10 years for symptomatic residual or adenoma regrowth can be observed[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although these functional outcomes are generally satisfactory, postoperative storage symptoms (PSS), including frequency, urgency, and some degree of subjective burning, are often reported after HoLEP treatments, which present in approximately 30\u0026ndash;68% of patients and usually persists for one-to-three month period until they resolve spontaneously[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite self-limiting of such adverse events, they could be bothersome and significantly interfere with the patients\u0026rsquo; daily activities, especially in the early stages after catheter removal[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNaspro et al. proposed that certain symptoms after HoLEP are probably caused by the high energy applied to the capsule during the procedure[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, it was raised that the laser energy applied during the procedure might be beneficial with respect to hemostasis, but some patients could pay the price of PSSs[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Based on this theory, some urologists have suggested that the incidence of these complications might be decreased if shorter laser exposure or lower energy consumption of the prostatic capsule could be achieved through technical refinement[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, there is a lack of evidence in the literature to prove this. The effects of laser energy consumption on PSS in the early stages after HoLEP still remain unclear. Therefore, this study aimed to compare serial changes in postoperative symptoms between low and high energy consumed HoLEP procedures, in terms of the total International Prostate Symptom Score (IPSS) and subscores.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eEighty patients underwent HoLEP for LUTS/BPH at our hospital between May 2020 and December 2021, were included in this study. The 3-month follow-up data of all patients were available in our HoLEP: Epidemiology, Technique, and Follow-up (HETF) database. Patients who did not complete the follow-up protocol were excluded from the study. The clinical data were retrospectively reviewed with the approval of the Institutional Review Board of our hospital.\u003c/p\u003e \u003cp\u003eBaseline data included age, body mass index (BMI), prostate specific antigen (PSA), prostatic volume (PV), post-void residual urine volume (PVR), catheter dependency, preoperative IPSS and Quality of Life (QoL). Moreover, perioperative data including total laser energy (TLE) applied, enucleation time (ET), morcellation time (MT), prostate tissue removed (PTR), postoperative catheter duration, and surgery-related complications were evaluated.\u003c/p\u003e \u003cp\u003eSurgical intervention and follow-up\u003c/p\u003e \u003cp\u003eAll procedures were performed by a fellowship-trained experienced surgeon (KL) using a 26-Fr continuous-flow laser resectoscope with a 30\u0026deg; lens (STORZ\u0026reg;) and a tissue morcellator (Wolf Piranha\u0026reg; or Hawk\u0026reg;). A 90-Watt holmium laser device (Sphinx\u0026reg;, LISA) was applied with adjustment of 2.0 J, 30 Hz, pulse width 300\u0026micro;s for the entire procedure of each individual patient in this study.\u003c/p\u003e \u003cp\u003ePatients were followed up at 1, 2, and 3 weeks and then 1 and 3 months postoperatively. Symptom improvements after HoLEP were assessed with IPSS or IPSS\u0026thinsp;+\u0026thinsp;QoL at each follow-up and prospectively recorded in the HETF database. Because of traveling difficulty due to the Covid-19 pandemic, all patients in this study fulfilled their follow-up via a mobile application, which could send questionnaires automatically at each follow-up point.\u003c/p\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003cp\u003eThe low energy consumed (LEC) procedures were separated from high energy consumed (HEC) procedures by TLE applied during the procedure. Considering that PV and duration of the enucleation process have potential influences on laser exposure and TLE consumption, two variables described in previous literature were introduced to adjust TLE for PTR and ET, which were L/P ratio (TLE divided by the resected prostate weight in kJ/gm) and laser rate (TLE divided by the ET in kJ/min)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Patients were divided into two groups (low versus high) according to mean TLE, median L/P ratio (L/P), and mean laser rate (Lr), successively. Baseline and perioperative data were compared between groups. Furthermore, the IPSS at each follow-up point, including the subtotal voiding (IPSS-V) and storage (IPSS-S) symptom scores as well as the frequency, urgency, and nocturia scores, were compared between the groups.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were reported in terms of numbers and percentages for categorical variables, means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or medians and quartiles, depending on data distribution for continuous variables. Baseline and follow-up continuous data were compared using an independent t-test for normal distribution and the Mann-Whitney U test for non-normal distribution. Chi-Square or Fisher exact test was used to compare categorical variables. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Statistical Package for the Social Sciences (version 12.0) was used for the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean TLE, median L/P, and mean Lr of the 80 evaluated patients were 163.65(range, 41.90 \u0026minus;\u0026thinsp;426.22) kJ, 4.56(range, 1.42\u0026ndash;37.08) kJ/gm, and 1.98(range, 1.32\u0026ndash;2.63) kJ/min, respectively. A summary of the periprocedural data is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was a significantly lower mean TLE in the low-TLE group 109.94\u0026thinsp;\u0026plusmn;\u0026thinsp;28.134 kJ than in the high-TLE group 217.36\u0026thinsp;\u0026plusmn;\u0026thinsp;54.042 kJ, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The mean PV, median PSA, mean ET, median MT, median PTR, and mean enucleation efficiency (EE) in the low-TLE group were significantly lower than those in the high-TLE group, whereas the median L/P in the low-TLE group was significantly higher than that in the high-TLE group. There was a significantly lower median L/P in the low-L/P group 3.18(2.40,3.96) kJ/gm than in high-L/P group 7.19(4.97,10.54) kJ/gm, P\u0026lt;0.001. The mean age, mean PV, proportion of IPP, median MT, median PTR, and mean EE were significantly higher in the low-L/P group than in the high-L/P group. Moreover, there was a significantly lower mean Lr in the low-Lr group 1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.030 kJ/min than in high-Lr group 2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026 kJ/min, P\u0026lt;0.001. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline between the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal laser energy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eL/P ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eLaser rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.03\u0026thinsp;\u0026plusmn;\u0026thinsp;8.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.15\u0026thinsp;\u0026plusmn;\u0026thinsp;8.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.03\u0026thinsp;\u0026plusmn;\u0026thinsp;8.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.15\u0026thinsp;\u0026plusmn;\u0026thinsp;8.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e71.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePV (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.17\u0026thinsp;\u0026plusmn;\u0026thinsp;21.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.63\u0026thinsp;\u0026plusmn;\u0026thinsp;42.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.65\u0026thinsp;\u0026plusmn;\u0026thinsp;41.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.14\u0026thinsp;\u0026plusmn;\u0026thinsp;26.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e67.95\u0026thinsp;\u0026plusmn;\u0026thinsp;30.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e78.84\u0026thinsp;\u0026plusmn;\u0026thinsp;48.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPP* (\u0026gt;5mm) (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.61(1.37, 4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.85(3.59, 11.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.20(2.94, 6.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.16(1.49, 8.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.12(2.40, 7.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.55(1.75, 7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVR^ (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.05(5.73, 120.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.5(10,140.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.05(9.7, 107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47(10, 155)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38(7.15,149.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42.9(9.9, 113.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheter dependency (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnucleation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.45\u0026thinsp;\u0026plusmn;\u0026thinsp;16.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107.03\u0026thinsp;\u0026plusmn;\u0026thinsp;22.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.58\u0026thinsp;\u0026plusmn;\u0026thinsp;26.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.90\u0026thinsp;\u0026plusmn;\u0026thinsp;34.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e84.60\u0026thinsp;\u0026plusmn;\u0026thinsp;29.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80.88\u0026thinsp;\u0026plusmn;\u0026thinsp;33.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorcellation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.5(3, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(7.5, 18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(8.25,21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(3, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9(5.25, 14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.5(4.25, 16.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResected prostate weight (gm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.57(9.93, 32.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.41(37.75, 84.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.51(34.01, 81.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.03(9.93, 35.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35.40(22.93, 59.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33.47(19.2, 62.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnucleation efficiency (gm/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal laser energy (kJ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109.94\u0026thinsp;\u0026plusmn;\u0026thinsp;28.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217.36\u0026thinsp;\u0026plusmn;\u0026thinsp;54.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e176.26\u0026thinsp;\u0026plusmn;\u0026thinsp;61.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151.04\u0026thinsp;\u0026plusmn;\u0026thinsp;74.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e148.36\u0026thinsp;\u0026plusmn;\u0026thinsp;53.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e178.94\u0026thinsp;\u0026plusmn;\u0026thinsp;79.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL/P ratio (kJ/gm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.37(3.77, 9.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.18(2.48, 4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.18(2.40, 3.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.19(4.97, 10.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.33(3.13, 6.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.64(3.61, 8.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaser rate (kJ/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheter duration (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2 ,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2(2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e*Intravesical prostatic protrusion\u003c/p\u003e \u003cp\u003e^Post-void residual\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean baseline IPSS, IPSS-S, and IPSS-V scores were comparable between the groups. However, the 1-week and 3-week postoperative IPSS-V in the low-TLE group were significantly higher than in high-TLE group (5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52 versus 3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36, P\u0026thinsp;=\u0026thinsp;0.034; 3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53 versus 1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97, P\u0026lt;0.001, respectively). Similarly, the 3-month postoperative IPSS-V in the low-TLE group was significantly higher than in high-TLE group (3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68 versus 1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22, P\u0026thinsp;=\u0026thinsp;0.019). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Furthermore, the only significant difference of storage symptom was the urgency scores between the high-TLE group and low-TLE group at 1 month follow-up, which was 1(0,2) versus 1(0,1) (P\u0026thinsp;=\u0026thinsp;0.042). (Supplementary Table\u0026nbsp;1, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of functional outcomes between the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal laser energy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eL/P ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eLaser rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.80\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.68\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-week follow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.59\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e 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colname=\"c7\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-week follow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e 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colname=\"c3\"\u003e \u003cp\u003e7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month follow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.46\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-month follow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-S\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cp\u003eThe incidence of urinary incontinence at 1-month, 3-month and 6-month follow-ups was 22.5%, 10.0%, and 6.3%, respectively. All of them were self-relieved within one year after surgery. There were complications observed in this cohort including 3 dysuria after removal of the catheter needed re-catheterization (Clavien Ⅰ), 3 bulbar strictures (Clavien Ⅲa) and one urethral meatus stenosis (Clavien Ⅲa) cured by regular urethrotomy. Other surgery-related complications included one superficial bladder mucosa injury during morcellation (Clavien I) prolonging the catheter indwelling, and one long-term postoperative hemorrhage requiring bladder irrigation in the E.R.. (Clavien Ⅱ). There were no significant differences between groups regarding incidence of postoperative urinary incontinence and complications. (Supplementary Table\u0026nbsp;2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHoLEP has been currently accepted as the first line surgical option for the management of symptoms secondary to BPH. Several large cohort studies have been published with excellent outcomes regarding the long-term improvement of LUTS and sustained reduction of IPSS more than one year postoperatively[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, it is not uncommon for patients to experience persistent or even aggravated storage symptoms in the early postoperative period. Although most of them are limited duration and self-relieved, the irritative bladder will in particular adversely affect quality of life and interfere with the patients\u0026rsquo; daily activities[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, controversial discussions regarding low-power HoLEP have been evolved focusing on its technical feasibility, equal efficiency and, more importantly, the potential advantages compared with high-power HoLEP, such as mild irritative symptoms in the convalescence period and less impact on the urinary sphincter. There were two high quality randomized trial compared low-power with high-power HoLEP procedures regarding functional outcomes[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Unexpectedly, no significant differences between the groups were revealed with regard to IPSS at each follow-up point, which challenges the concept that lower laser energy will reduce PSSs. Notably, none of the aforementioned studies reported TLE during the procedure. Therefore, it is uncertain whether the application of a high-power laser is associated with a more energy consumed procedure. Furthermore, Elshal et al. reported that the median laser energy applied in relation to the enucleation weight did not significantly differ between low-power and high-power procedures, which confused the relationship between the laser device and energy consumption[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Interestingly, the present study revealed that similar to TLE, the L/P ratio also depends on the PV. However, a prostate with a smaller volume is associated with a lower TLE, but a higher L/P ratio. A possible explanation for this finding might be that more energy is needed when accessing the capsule or dissecting the gland due to the relative indistinct or adhesive surgical plane of the smaller prostate.\u003c/p\u003e \u003cp\u003eRecently, Westhofen et al. first assessed the impact of TLE on short-term functional outcomes after HoLEP and reported that there was no significant correlation between TLE and postoperative IPSS[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In line with this result, the present study confirmed that both low-TLE and high-TLE groups had comparable storage symptoms and total IPSS. Furthermore, similar results were observed despite adjustment of TLE for enucleation weight or ET. The only significant difference appeared in the improvement of voiding symptom between the high-TLE and low-TLE groups. The greater change in IPSS-V in the high-TLE group can be attributed to the remarkable relief from urethral resistance due to the greater amount of tissue retrieved, depending on the prostatic volume.\u003c/p\u003e \u003cp\u003eAs mentioned above, there have been many scientific evidences of the long-term relief of LUTS after HoLEP. However, rare data in previous literatures focused on the early-stage improvement of symptoms. A randomized trial comparing functional outcomes of HoLEP versus TURP noted that the patients didn\u0026rsquo;t achieve a remarkable reduction of the symptom score after HoLEP compared with TURP at the 1-month follow-up[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Unfortunately, there was only 1-month or even 3-month data in the previous literatures regarding the comparison of low-power and high-power procedures. Thus, the effects of holmium laser on the status of patients within one month after catheter removal are still unclear. Fayad et al. reported a steep drop of IPSS from one week to 2-week time point after HoLEP[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, the relatively postponed follow-up might lose some important information about symptoms at a very early postoperative stage. To compensate for this deficiency in previous studies, we set the first follow-up point at one week after surgery, when the most severe post-HoLEP symptoms were presented. However, we failed to demonstrate significant differences between the LEC and HEC groups within one month.\u003c/p\u003e \u003cp\u003eA holmium laser pulse can generate plasma bubbles between the tip of the fiber and the target tissue. In an in vitro study, Cecchetti et al. reported that when the holmium laser was set to 1.5 J and 20 Hz, the temperature at 2 mm from the tip of the fiber was 750\u0026deg;C, while the temperature at 0.5 mm laterally from the edge of the fiber was 350\u0026deg;C[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition to producing pressure waves for adenoma dissection, the expansion and collapse of the hot water vapor bubble also coincidentally deliver coagulating effects for hemostasis. In fact, the \"whitening effect\u0026rdquo;, which refers to the blanching of capsule tissue, is observed during the enucleation process. This confirmed that hemostasis takes place during the entire procedure to preserve optimal vision because of the unique characteristics of the holmium laser[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the extensive coagulation zone and remaining necrotic tissue due to the effect of heat on the capsule may negatively impact symptom improvement in the initial postoperative period[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Considering that the tissue thickness at which 90% of the energy is absorbed is a constant value known as the penetration depth, the severity of this heat injury solely depends on the laser wavelength and is not affected by the power output of the laser[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This is a possible reason why it failed to demonstrate a correlation between postoperative symptom score and laser energy consumption.\u003c/p\u003e \u003cp\u003eThe results reported herein should be considered in light of some limitations. The retrospective nature and small sample size may have resulted in a selection bias. The insufficient sample size limited us to apply statistical measurements, such as propensity score matching analysis, to prevent this. However, there were no significant differences between the groups regarding baseline symptom scores. Therefore, valid conclusions could be drawn based on this cohort. Moreover, the lack of preoperative urodynamic data may also influence our estimates. Some conditions, including non-neurogenic overactive or low compliance bladder, were not excluded from the cohort, which may negatively affect the early improvement of storage symptoms and probably impact the conclusions. Further prospective studies with larger cohorts are needed to confirm our findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eLow and high energy consumption have similar effects on symptom improvement after HoLEP. Higher laser energy does not result in more severe postoperative storage symptoms in the early stage following the procedure. Further research can be built on this foundation to reveal the true differences in functional outcomes between low-power and high-power HoLEP.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article. No funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u0026nbsp;\u003c/strong\u003eK Liu: conceptualization, data curation, formal analysis and writing\u0026ndash;review \u0026amp; editing. Y Zong: data curation and writing\u0026ndash;original draft. R Xiao: data curation. S Tang: data curation. J Ye: writing\u0026ndash;review. L Zhao: supervision. C Xiao: supervision. S Zhang: resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with ethical standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e The study was approved by our institutional ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are located in controlled access data storage at Peking University Third Hospital and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. 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BJU Int 90(9):863\u0026ndash;869. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1046/j.1464-410x.2002.03071.x\u003c/span\u003e\u003cspan address=\"https://doi:10.1046/j.1464-410x.2002.03071.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHermanns T, Sulser T, Fatzer M, Baumgartner MK, Rey JM, Sigrist MW, Seifert HH (2009) Laser fire deterioration and loss of power output during photo-selective 80-w potassium-titanylphosphate laser vaporization of the prostate. Eur Urol 55(3):679\u0026ndash;685. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1016/j.eururo.2008.03.035\u003c/span\u003e\u003cspan address=\"https://doi:10.1016/j.eururo.2008.03.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho MC, Ha SB, Oh S-J, Kim SW, Paick J-S (2015) Change in storage symptoms following laser prostatectomy: comparison between photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). World J Urol 33(8):1173\u0026ndash;1180. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1007/s00345-014-1424-0\u003c/span\u003e\u003cspan address=\"https://doi:10.1007/s00345-014-1424-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmiliani E, Talso M, Haddad M, Pouliquen C, Derman J, C\u0026ocirc;t\u0026eacute; JF, Doizi S, Mill\u0026aacute;n F, Berthe L, Audouin M, Traxer O (2018) The True Ablation Effect of Holmium YAG Laser on Soft Tissue. J Endourol 32(3):230\u0026ndash;235. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1089/end.2017.0835\u003c/span\u003e\u003cspan address=\"https://doi:10.1089/end.2017.0835\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"benign prostatic hyperplasia, enucleation, laser energy, lower urinary tract symptoms, follow-up","lastPublishedDoi":"10.21203/rs.3.rs-5736945/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5736945/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo compare early-stage lower urinary tract symptoms following low and high energy consumed holmium laser enucleation of the prostate (HoLEP).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEighty patients who underwent HoLEP at our hospital between May 2020 and December 2021 were retrospectively evaluated. All procedures were performed applying a single laser device with the same power settings. Patients were divided equally into two groups (low vs. high) according to total laser energy (TLE), L/P ratio (TLE/resected prostate weight), and laser rate (TLE/enucleation time), successively. The follow-up points included 1-week, 2-week, 3-week, 1-month, and 3-month, postoperatively. The International Prostate Symptom Score (IPSS) and the subscores of storage (IPSS-S) and voiding (IPSS-V) were assessed and compared between the two groups. Urinary incontinence and complications were also compared between the groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean baseline IPSS, IPSS-S, and IPSS-V scores were comparable between the groups. The 1-week, 3-week, and 3-month IPSS-V in the low-TLE group were significantly higher than that in high-TLE group (5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5vs3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36, P\u0026thinsp;=\u0026thinsp;0.034; 3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53vs1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97, P\u0026lt;0.001, 3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68vs1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22, P\u0026thinsp;=\u0026thinsp;0.019, respectively). No significant differences between the groups were revealed when TLE was adjusted for enucleation weight (L/P ratio) or enucleation time (laser rate). There were also no significant differences between the groups regarding urinary incontinence and complications at each follow-up point.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLow and high energy consumption have similar effects on symptoms in the early stages after HoLEP. Higher laser energy does not result in more severe postoperative storage symptoms.\u003c/p\u003e","manuscriptTitle":"Effect of Laser Energy Consumption on Early-Stage LUTS after HoLEP: Comparison of Symptom Improvements between Low and High Energy Consumed Procedures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-02 09:06:00","doi":"10.21203/rs.3.rs-5736945/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":"0330df34-d383-40f4-8aa2-562569a123a9","owner":[],"postedDate":"January 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T12:12:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-02 09:06:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5736945","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5736945","identity":"rs-5736945","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}