Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume <100 g:  A Pilot Randomized Controlled Trial

Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume <100 g: A Pilot Randomized Controlled Trial | 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 Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume <100 g: A Pilot Randomized Controlled Trial Sayed Md Asfaque Aamir This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8134670/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 Background: Benign prostatic hyperplasia (BPH) frequently affects ageing men, and surgical intervention is often required when medical therapy fails. Holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate photoselective vaporization (KTP PVP) are widely used minimally invasive options, yet comparative data in prostates <100 g remain limited. Objective: To compare perioperative outcomes, early recovery, and short-term functional results between HoLEP and KTP PVP in men with moderate-sized prostates (12, Qmax <15 mL/s, prostate 40–100 g). Participants were randomized equally to HoLEP or KTP PVP. Outcomes assessed included intraoperative parameters, postoperative recovery, complications, and functional results (IPSS, Qmax, PVR, voided volume) at 1, 3, and 6 months. Results: Baseline demographics and symptom burden were comparable between groups. KTP PVP showed significantly lower hemoglobin drop (0.6 vs 1.1 g/dL, p < 0.001) and shorter duration of hematuria (1.6 vs 2.3 days, p < 0.01). Operative time was slightly shorter with KTP but not significant (p = 0.07). Both procedures produced significant improvements in LUTS, flow rate, and PVR at all follow-up points. At 6 months, HoLEP demonstrated superior functional outcomes: lower IPSS (6.0 vs 7.5, p = 0.04), higher Qmax (22.4 vs 19.6 mL/s, p = 0.03), lower PVR (28 vs 38 mL, p = 0.01), and higher voided volume (310 vs 280 mL, p = 0.04). Complication rates were low and similar. Re-intervention was needed in two KTP cases and none in HoLEP. Conclusion: Both HoLEP and KTP PVP are safe and effective for prostates <100 g. KTP offers advantages of reduced bleeding and faster early recovery, while HoLEP provides superior 6-month functional outcomes and fewer re-interventions. Procedure choice should be individualized based on patient profile, surgeon expertise, and resource availability. INTRODUCTION Benign prostatic hyperplasia is a leading cause of LUTS in men over the age of 50, with increasing prevalence with advancing age. Even though medical therapy remains the initial approach, a significant proportion of patients ultimately land up requiring surgical intervention. Historically, TURP was considered the gold standard, which stands tall in peripheral institutes. But recent advances in lasers have provided effective alternatives with reduced perioperative morbidity. Holmium laser enucleation of the prostate (HoLEP) has demonstrated consistent efficacy across wider range of prostate volume allowing complete adenoma removal with durable long-term outcomes[ 1 ]. Potassium-titanyl-phosphate (KTP) photo-selective vaporization of the prostate (PVP), has established itself as a safe and effective option, particularly for patients with bleeding risks, owing to its superior side firing hemostatic property[ 2 ]. Most comparative studies include a heterogeneous patient population, with gland sizes ranging widely, making it difficult to draw conclusions for men with prostates under 100 g—a group that constitutes the bulk of surgical BPH cases in many centers[ 3 ]. Moreover, urologists often face the dilemma of selecting between a size-independent enucleation technique and a vaporization approach that offers rapid recovery. Cost efficacy and patient affordability also poses hindrance in patient acquisition which can be easily taken care in government institutes. This pilot randomized controlled trial was undertaken to directly compare perioperative outcomes, complication rates and patient response between HoLEP and KTP PVP in men with moderate-sized prostates (< 100 g), with the aim of generating focused data for this common clinical scenario to be implemented with a larger sample size in the future. METHODOLOGY Study Design and Participants This prospective, single centre study RCT was conducted in the Dept. of Urology at MKCG Medical College & Hospital, Berhampur from Jan 2024 to June 2025 after obtaining an institutional ethical clearance & written consent from the participants. Included patients were men aged 50–80 years with symptomatic BPH (IPSS > 12), peak urinary flow rate (Qmax) < 15 mL/s, prostate volume between 40–100 g on transabdominal ultrasound, and no prior prostate surgery. Excluded patients were suspected or confirmed prostate cancer, urethral stricture, neurogenic bladder, active urinary tract infection, coagulopathies, CKD patients. Randomization and Intervention Participants were randomized into two groups of 30 each: Group A (HoLEP) : Subjects underwent allotted procedure using a 100-W holmium:YAG laser with standard three-lobe enucleation technique Group B (KTP PVP) : Subjects underwent allotted procedure using a 180-W GreenLight laser photo-vaporization until visualisation of a clear prostatic capsule . All patients underwent basic pre-operative routine blood investigations, transabdominal ultrasound with Post-Voidal Residual Urine, Uroflowmetry, Pre-operative cystoscopy, Sr.PSA. Preoperative Data Collection Parameters recorded included Age, Prostate Volume, Baseline IPSS, Baseline Qmax Outcome Measures Intraoperative parameters: Capsular perforation Conversion to TURP Transfusion requirement Operative time (skin-to-skin) Complications (Clavien–Dindo classification) Postoperative parameters: Drop in Haemoglobin (POD-1) AUR requiring re-catheterization Clot retention Duration of hematuria (days) Fever (> 38°C) Qmax after catheter removal (day 1) Hospital Stay (Hours) Follow-up protocol Follow-up protocol Patient were followed up at 1,3,6 months postoperatively. At each follow-up visit, parameters of assessment included IPSS questionnaires, uroflowmetry (Qmax), voided volume, and post-void residual urine estimation by ultrasonography. Complications such as dysuria, urinary tract infection, incontinence, sexual dysfunction were recorded at every visit. Statistical Analysis Continuous variables were analyzed using Student’s t-test, categorical variables with Chi-square test. p < 0.05 was considered statistically significant. Ethics Declaration This study was conducted in accordance with the Declaration of Helsinki (2013 revision) and the Indian Council of Medical Research (ICMR) National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017/2020) . Institutional Ethics Committee approval was obtained from MKCG Medical College & Hospital, Berhampur , and written informed consent was obtained from all participants prior to enrolment. RESULTS Preoperative Characteristics Both groups had similar baseline demographics and clinical presentation (Table 1). The mean age was 66.4 ± 5.9 years in the HoLEP group and 67.1 ± 6.2 years in the KTP PVP group (p = 0.64). Mean prostate volume was similar between the two groups (72.5 ± 14.3 g for HoLEP vs 70.8 ± 13.9 g for KTP PVP; p = 0.58). Baseline symptom severity, assessed by IPSS, showed no significant difference (24.3 ± 4.2 vs 23.9 ± 4.5; p = 0.72). Likewise, baseline urinary flow rates (Qmax) were almost identical, with values of 7.8 ± 2.1 mL/s in the HoLEP arm and 8.0 ± 2.0 mL/s in the KTP PVP arm (p = 0.67). Intraoperative Outcomes The mean operative time was slightly shorter in the KTP PVP group (62.4 ± 8.9 minutes) compared to HoLEP (68.7 ± 10.2 minutes),but this did not attain statistical significance in our study design (p = 0.07). (Table 2) The Mean drop in hemoglobin was less with KTP PVP (0.6 ± 0.3 g/dL) in comparison to HoLEP (1.1 ± 0.4 g/dL; p < 0.001) depicting clear intraoperative field during surgery. (Table 2) Capsular perforation was seenin two patients (6.7%) in the HoLEP group, with no such incidence in the KTP PVP group (p = 0.15). (Table 2) One patient in the KTP arm required TURP to complete the procedure due to inadequate vaporization and incorrect size estimation pre-operatively (p = 0.31). There was no requirement of Blood Transfusion in either of the study arm. Early Postoperative Outcomes Postoperative recovery parameters as depicted in Table 3 indicated acute urinary retention requiring re-catheterization post-cfvt in one patient (3.3%) in the HoLEP group and two patients (6.6%) in the KTP PVP group (p = 0.55). Clot retention was reported in only one HoLEP patient (3.3%). Duration of postoperative hematuria was significantly shorter in the KTP PVP group (1.6 ± 0.6 days) compared to HoLEP (2.3 ± 0.8 days; p < 0.01). On post-operative day 1 after catheter removal, mean Qmax improved significantly in both groups—20.5 ± 3.8 mL/s (HoLEP) vs 19.9 ± 3.5 mL/s (KTP PVP)—with no significant difference (p = 0.54). Follow-up Outcomes At baseline, both groups were similar along the lines of IPSS, Qmax, post-void residual urine , and voided volume. (Table 4) After surgery, both arms demonstrated significant improvements across all functional parameters. By 6 months, HoLEP group gave a better reduction in IPSS (6.0 ± 2.4 vs. 7.5 ± 2.7, p = 0.04) and elevated Qmax (22.4 ± 5.1 vs. 19.6 ± 4.7 mL/s, p = 0.03) when compared to KTP group. Following same pattern, PVR was lower (28 ± 12 vs. 38 ± 14 mL, p = 0.01), and voiding volume was better (310 ± 64 vs. 280 ± 66 mL, p = 0.04) in the HoLEP group at 6 months. Complication rates were low and similar between the two groups, with no significant difference in the incidence of dysuria, incontinence or sexual dysfunction. Two patients in the KTP PVP group required re-intervention for persistent symptoms, whereas none in the HoLEP group required further intervention (p = 0.15). Discussion This pilot study contrasts holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate photo selective vaporization (KTP PVP) patients of symptomatic benign prostatic hyperplasia below volume of 100 g. Intraoperative parameters showed certain notable trends. The mean operative time was apparently shorter in the KTP PVP group, findings consistent with the case series by Bachmann et al. (2005), who observed that vaporization required less operative time in moderately enlarged glands because of no requirement of morcellation. Although this difference in our study did not reach statistical significance (p = 0.07), it suggests a possible procedural efficiency advantage with KTP in prostates under 100 g. The reduction in hemoglobin drop in the KTP PVP group compared to HoLEP (0.6 vs. 1.1 g/dL, p < 0.001) mimics the results reported by Ruszat et al. (2008), underscoring the photo-selective laser’s hemostatic properties[ 4 ]. Capsular perforations were minimal and occurred only in the HoLEP group, consistent with the enucleation technique’s proximity to the prostatic capsule, as noted by Elzayat and Elhilali (2007). Postoperative parameters were similarly comparable between the groups, with both showing early improvements in Qmax (POD-1: 20.5 vs. 19.9 mL/s). This finding is along the lines of reports by Gilling et al. (2008) for HoLEP and by Thomas et al. (2016) for KTP PVP[ 5 ]. Duration of hematuria was significantly shorter in the KTP group, which is in tangent with the superior coagulation profile previously described for photoselective vaporization (Te et al., 2008). Occurence of acute urinary retention requiring re-catheterization , clot retention , and febrile episodes were low across both groups, indicating that perioperative hassles are acceptably low for both modalities. On follow up, both HoLEP and KTP laser vaporization demonstrated significant improvements in LUTS outcomes, as reflected by fall in the IPSS scores, increases in Qmax, fall in PVR, and improved voided volumes at follow-up. These findings are in line with previously published randomized trials and meta-analyses. Elzayat and Elhilali reported that HoLEP offers durable improvements in urinary symptoms and flow rates, with functional outcomes equivalent or superior to TURP. In our series, however, HoLEP showed superior outcomes at 6 months, with significantly lower IPSS and PVR and higher Qmax and voided volume compared to KTP. This observation is supported by the randomized controlled trial by Bouchier-Hayes et al., which found that HoLEP resulted in greater improvements in flow rates and post-void residual urine than PVP at 6 and 12 months[ 6 ]. Furthermore, a meta-analysis by Tan et al. concluded that HoLEP provides better functional durability than PVP, particularly in prostates of larger volume. The complication profile in our cohort was low and comparable between the two groups. Transient dysuria was the most common adverse events, with no significant difference between HoLEP and KTP, echoing findings from earlier series. Importantly, the risk of incontinence and sexual dysfunction remained minimal at the end of 6 months, proportioning with prior studies showing that both laser modalities preserve safety while achieving effective debulking of the adenoma . Long-term complication rates remained low, with no significant differences in bladder neck stenosis, urethral stricture formation, or residual urine volumes between the groups. Our re-intervention rate was slightly higher in the KTP arm, a finding that has been variably reported in the literature — with Malek et al. (2012) noting higher re-treatment needs for vaporization compared to enucleation in certain long-term series, possibly due to incomplete removal of adenomatous tissue in some cases.[ 7 ] On side by side together, our results suggest that both HoLEP and KTP PVP provide proportionately similar clinical improvements and safety profiles with HoLEP providing better long-term functional outcomes and those with larger prostate glands with lower re-intervention rates as suggested by prior meta-analyses (Ahmed et al.2021) with KTP PVP offering a slight advantage in terms of reduced hemoglobin loss and shorter duration of hematuria. Limitations of the present study was limited by its modest sample size and short follow-up, but the consistency of our findings with established literature establishes its validity. Extension of this pilot study along multicentre is needed further to probe and gauge the efficacy of these modalities. Conclusion Both HoLEP and KTP PVP are safe, effective, and well-tolerated for prostates under 100 g, offering comparable functional improvements[ 8 ]. KTP PVP was better in terms of reduced hemoglobin loss and shorter duration of hematuria, while HoLEP gives complete adenoma removal and potentially fewer future re-exploration[ 9 ]. But ultimately, the choice of procedure should be governed on the basis of patient characteristics, surgical expertise, and available resources in the institute. Declarations Ethical Approval: MKCG Medical College and Hospital, Berhampur Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors Conflict of Interest: The authors declare no conflict of interest. Informed Consent: Written informed consent was obtained from all participants. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors Author Contribution Author, Co-Author - Data Collection, Tabulation, Interpretation and Research Article Writing References Gilling PJ, Kennett KM, Das AK, Thompson D, Fraundorfer MR (2000) Holmium laser enucleation of the prostate (HoLEP) for glands larger than 100 g: an endourologic alternative to open prostatectomy. J Urol 164(3):971–975 Malek RS, Kuntzman RS, Barrett DM (2000) High power potassium-titanyl-phosphate laser vaporization prostatectomy: 24 hours later. Urology 55(5):769–772 Bachmann A, Schürch L, Ruszat R et al (2005) Photoselective vaporization of the prostate: the Basel experience after 1000 cases. Eur Urol 47(6):798–804 Ruszat R, Seitz M, Wyler SF et al (2008) GreenLight laser vaporization versus transurethral resection of the prostate: 2-year results of a prospective randomized trial. Eur Urol 54(5):1058–1066 Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation and transurethral resection of the prostate: results at 7 years. Eur Urol 61(4):747–754 Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Gilling PJ (2010) A randomized trial of photoselective vaporization of the prostate vs holmium laser enucleation of the prostate: results at 2 years. BJU Int 105(7):964–969 Malek RS, Barrett DM, Kuntzman RS (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344–1348 Tan A, Liao C, Mo Z, Cao Y (2016) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate and photoselective vaporization of the prostate in the treatment of benign prostatic obstruction. BJU Int 117(4):614–623 Ahmed K, El Tayeb MM, Barod R et al (2021) Holmium laser enucleation versus photoselective vaporization of the prostate: systematic review and meta-analysis. J Endourol 35(9):1255–1266 Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx 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-8134670","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":558463354,"identity":"84c1f429-b0ed-44e7-938f-e61dce96f237","order_by":0,"name":"Sayed Md Asfaque Aamir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYDACHgglA8SMD0B8PmK1gChmAxCDjRQtbBIgFkEtuj2HH7/m3WPDw8+/xqzya46dDBsD88NHN/BoMTvbZmbN8yyNR3LGG7PbstuSgQ5jMzbOwaflPA+bMc+BwzwGN86Y3ZbcxgzUwsMmTbSWYslt9URoOdvD/Bis5XyPGePHbYeJ0HLmmBnjnAMgv7AVSzNuO87DxkzIL2eSH394c8BGjp//8MaPP7dV2/OzNz98jE8LAyw6GCQyDJjBkcSMXzlYyQcwxX/8AeMPwqpHwSgYBaNgBAIASmREl9NsfgIAAAAASUVORK5CYII=","orcid":"","institution":"Maharaja Krishna Chandra Gajapati Medical College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Sayed","middleName":"Md Asfaque","lastName":"Aa","suffix":"Md"}],"badges":[],"createdAt":"2025-11-17 11:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8134670/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8134670/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98430514,"identity":"ffc0f238-a3d6-4869-8086-56ffdd406463","added_by":"auto","created_at":"2025-12-17 16:45:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43460,"visible":true,"origin":"","legend":"","description":"","filename":"paper1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/ea229174945282a4503e1037.docx"},{"id":98430503,"identity":"e0dc86e4-b88c-4a7a-898b-bb535a760887","added_by":"auto","created_at":"2025-12-17 16:45:36","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3866,"visible":true,"origin":"","legend":"","description":"","filename":"ed1f1bade6514484a81a24b86edac5ea.json","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/f777225d7dea35d408f3a50d.json"},{"id":98097494,"identity":"1c936cd8-e7b0-4710-b2ae-61f4bd435f71","added_by":"auto","created_at":"2025-12-12 19:26:01","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63324,"visible":true,"origin":"","legend":"","description":"","filename":"ed1f1bade6514484a81a24b86edac5ea1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/36875ed8282b4cd99f22bc38.xml"},{"id":98097492,"identity":"d0c7c87a-7db1-4d2a-942c-764e38ebbd29","added_by":"auto","created_at":"2025-12-12 19:26:01","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":61288,"visible":true,"origin":"","legend":"","description":"","filename":"ed1f1bade6514484a81a24b86edac5ea1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/26c33b35981ce09e8e99a2c1.xml"},{"id":98097496,"identity":"e081cf0b-6db7-47f0-82a9-225ce6382cdd","added_by":"auto","created_at":"2025-12-12 19:26:01","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74213,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/bf2c7df69c46e3a3990e6b84.html"},{"id":99502708,"identity":"bb0546c5-a1c4-4aca-91b8-25af1f217b25","added_by":"auto","created_at":"2026-01-05 07:56:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":899148,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/43c2f5d9-1f91-4d90-a4a6-697785a04226.pdf"},{"id":98097491,"identity":"cd3daaf1-e56e-4de9-bfb1-c50801b22ed4","added_by":"auto","created_at":"2025-12-12 19:26:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20142,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8134670/v1/26b84461502a51d334ed90d0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume \u003c100 g: A Pilot Randomized Controlled Trial","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBenign prostatic hyperplasia is a leading cause of LUTS in men over the age of 50, with increasing prevalence with advancing age. Even though medical therapy remains the initial approach, a significant proportion of patients ultimately land up requiring surgical intervention. Historically, TURP was considered the gold standard, which stands tall in peripheral institutes. But recent advances in lasers have provided effective alternatives with reduced perioperative morbidity.\u003c/p\u003e\u003cp\u003eHolmium laser enucleation of the prostate (HoLEP) has demonstrated consistent efficacy across wider range of prostate volume allowing complete adenoma removal with durable long-term outcomes[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Potassium-titanyl-phosphate (KTP) photo-selective vaporization of the prostate (PVP), has established itself as a safe and effective option, particularly for patients with bleeding risks, owing to its superior side firing hemostatic property[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost comparative studies include a heterogeneous patient population, with gland sizes ranging widely, making it difficult to draw conclusions for men with prostates under 100 g\u0026mdash;a group that constitutes the bulk of surgical BPH cases in many centers[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, urologists often face the dilemma of selecting between a size-independent enucleation technique and a vaporization approach that offers rapid recovery. Cost efficacy and patient affordability also poses hindrance in patient acquisition which can be easily taken care in government institutes.\u003c/p\u003e\u003cp\u003eThis pilot randomized controlled trial was undertaken to directly compare perioperative outcomes, complication rates and patient response between HoLEP and KTP PVP in men with moderate-sized prostates (\u0026lt;\u0026thinsp;100 g), with the aim of generating focused data for this common clinical scenario to be implemented with a larger sample size in the future.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis prospective, single centre study RCT was conducted in the Dept. of Urology at MKCG Medical College \u0026amp; Hospital, Berhampur from Jan 2024 to June 2025 after obtaining an institutional ethical clearance \u0026amp; written consent from the participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIncluded patients\u003c/b\u003e were men aged 50\u0026ndash;80 years with symptomatic BPH (IPSS\u0026thinsp;\u0026gt;\u0026thinsp;12), peak urinary flow rate (Qmax)\u0026thinsp;\u0026lt;\u0026thinsp;15 mL/s, prostate volume between 40\u0026ndash;100 g on transabdominal ultrasound, and no prior prostate surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExcluded patients\u003c/b\u003e were suspected or confirmed prostate cancer, urethral stricture, neurogenic bladder, active urinary tract infection, coagulopathies, CKD patients.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRandomization and Intervention\u003c/h3\u003e\n\u003cp\u003eParticipants were randomized into two groups of 30 each:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGroup A (HoLEP)\u003c/b\u003e: Subjects underwent allotted procedure using a 100-W holmium:YAG laser with standard three-lobe enucleation technique\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGroup B (KTP PVP)\u003c/b\u003e: Subjects underwent allotted procedure using a 180-W GreenLight laser photo-vaporization until visualisation of a clear prostatic capsule .\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAll patients underwent basic pre-operative routine blood investigations, transabdominal ultrasound with Post-Voidal Residual Urine, Uroflowmetry, Pre-operative cystoscopy, Sr.PSA.\u003c/p\u003e\n\u003ch3\u003ePreoperative Data Collection\u003c/h3\u003e\n\u003cp\u003eParameters recorded included Age, Prostate Volume, Baseline IPSS, Baseline Qmax\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eIntraoperative parameters:\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCapsular perforation\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConversion to TURP\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTransfusion requirement\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOperative time (skin-to-skin)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eComplications (Clavien\u0026ndash;Dindo classification)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative parameters:\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDrop in Haemoglobin (POD-1)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAUR requiring re-catheterization\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eClot retention\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDuration of hematuria (days)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFever (\u0026gt;\u0026thinsp;38\u0026deg;C)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eQmax after catheter removal (day 1)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHospital Stay (Hours)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eFollow-up protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eFollow-up protocol\u003c/div\u003e\u003cp\u003ePatient were followed up at 1,3,6 months postoperatively. At each follow-up visit, parameters of assessment included IPSS questionnaires, uroflowmetry (Qmax), voided volume, and post-void residual urine estimation by ultrasonography.\u003c/p\u003e\u003cp\u003eComplications such as dysuria, urinary tract infection, incontinence, sexual dysfunction were recorded at every visit.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were analyzed using Student\u0026rsquo;s t-test, categorical variables with Chi-square test. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEthics Declaration\u003c/h2\u003e\u003cp\u003eThis study was conducted \u003cb\u003ein accordance with the Declaration of Helsinki (2013 revision)\u003c/b\u003e and the \u003cb\u003eIndian Council of Medical Research (ICMR) National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017/2020)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eInstitutional Ethics Committee approval was obtained from \u003cb\u003eMKCG Medical College \u0026amp; Hospital, Berhampur\u003c/b\u003e, and \u003cb\u003ewritten informed consent\u003c/b\u003e was obtained from all participants prior to enrolment.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePreoperative Characteristics\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth groups had similar baseline demographics and clinical presentation (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean age was 66.4 \u0026plusmn; 5.9 years in the HoLEP group and 67.1 \u0026plusmn; 6.2 years in the KTP PVP group (p = 0.64).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMean prostate volume was similar between the two groups (72.5 \u0026plusmn; 14.3 g for HoLEP vs 70.8 \u0026plusmn; 13.9 g for KTP PVP; p = 0.58).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBaseline symptom severity, assessed by IPSS, showed no significant difference (24.3 \u0026plusmn; 4.2 vs 23.9 \u0026plusmn; 4.5; p = 0.72).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLikewise, baseline urinary flow rates (Qmax) were almost identical, with values of 7.8 \u0026plusmn; 2.1 mL/s in the HoLEP arm and 8.0 \u0026plusmn; 2.0 mL/s in the KTP PVP arm (p = 0.67).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eIntraoperative Outcomes\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003emean operative time\u003c/strong\u003e was slightly shorter in the KTP PVP group (62.4 \u0026plusmn; 8.9 minutes) compared to HoLEP (68.7 \u0026plusmn; 10.2 minutes),but this did not attain statistical significance in our study design (p = 0.07). (Table 2)\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003eMean drop in hemoglobin\u003c/strong\u003e was less with KTP PVP (0.6 \u0026plusmn; 0.3 g/dL) in comparison to HoLEP (1.1 \u0026plusmn; 0.4 g/dL; p \u0026lt; 0.001) depicting clear intraoperative field during surgery. (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCapsular perforation\u0026nbsp;\u003c/strong\u003ewas seenin two patients (6.7%) in the HoLEP group, with no such incidence in the KTP PVP group (p = 0.15). (Table 2)\u003c/p\u003e\n\u003cp\u003eOne patient in the KTP arm required TURP to complete the procedure due to inadequate vaporization and incorrect size estimation pre-operatively (p = 0.31).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was no requirement of Blood Transfusion in either of the study arm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEarly Postoperative Outcomes\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative recovery parameters as depicted in Table 3 indicated \u003cstrong\u003eacute urinary retention requiring re-catheterization\u003c/strong\u003e post-cfvt in one patient (3.3%) in the HoLEP group and two patients (6.6%) in the KTP PVP group (p = 0.55).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClot retention\u003c/strong\u003e was reported in only one HoLEP patient (3.3%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of postoperative hematuria\u003c/strong\u003e was significantly shorter in the KTP PVP group (1.6 \u0026plusmn; 0.6 days) compared to HoLEP (2.3 \u0026plusmn; 0.8 days; p \u0026lt; 0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn post-operative day 1 after catheter removal, \u003cstrong\u003emean Qmax\u0026nbsp;\u003c/strong\u003eimproved significantly in both groups\u0026mdash;20.5 \u0026plusmn; 3.8 mL/s (HoLEP) vs 19.9 \u0026plusmn; 3.5 mL/s (KTP PVP)\u0026mdash;with no significant difference (p = 0.54).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFollow-up Outcomes\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt baseline, both groups were similar along the lines of IPSS, Qmax, post-void residual urine , and voided volume. (Table 4)\u003c/p\u003e\n\u003cp\u003eAfter surgery, both arms demonstrated significant improvements across all functional parameters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy 6 months, HoLEP group gave a better reduction in IPSS (6.0 \u0026plusmn; 2.4 vs. 7.5 \u0026plusmn; 2.7, \u003cem\u003ep\u003c/em\u003e = 0.04) and elevated Qmax (22.4 \u0026plusmn; 5.1 vs. 19.6 \u0026plusmn; 4.7 mL/s, \u003cem\u003ep\u003c/em\u003e = 0.03) when compared to KTP group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing same pattern, PVR was lower (28 \u0026plusmn; 12 vs. 38 \u0026plusmn; 14 mL, \u003cem\u003ep\u003c/em\u003e = 0.01), and voiding volume was better (310 \u0026plusmn; 64 vs. 280 \u0026plusmn; 66 mL, \u003cem\u003ep\u003c/em\u003e = 0.04) in the HoLEP group at 6 months.\u003c/p\u003e\n\u003cp\u003eComplication rates were low and similar between the two groups, with no significant difference in the incidence of dysuria, incontinence or sexual dysfunction.\u003c/p\u003e\n\u003cp\u003eTwo patients in the KTP PVP group required re-intervention for persistent symptoms, whereas none in the HoLEP group required further intervention (p = 0.15).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis pilot study contrasts holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate photo selective vaporization (KTP PVP) patients of symptomatic benign prostatic hyperplasia below volume of 100 g.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntraoperative parameters\u003c/b\u003e showed certain notable trends. The \u003cb\u003emean operative time\u003c/b\u003e was apparently shorter in the KTP PVP group, findings consistent with the case series by Bachmann et al. (2005), who observed that vaporization required less operative time in moderately enlarged glands because of no requirement of morcellation. Although this difference in our study did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.07), it suggests a possible procedural efficiency advantage with KTP in prostates under 100 g. The \u003cb\u003ereduction in hemoglobin\u003c/b\u003e drop in the KTP PVP group compared to HoLEP (0.6 vs. 1.1 g/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) mimics the results reported by Ruszat et al. (2008), underscoring the photo-selective laser\u0026rsquo;s hemostatic properties[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cb\u003eCapsular perforations\u003c/b\u003e were minimal and occurred only in the HoLEP group, consistent with the enucleation technique\u0026rsquo;s proximity to the prostatic capsule, as noted by Elzayat and Elhilali (2007).\u003c/p\u003e\u003cp\u003e\u003cb\u003ePostoperative parameters\u003c/b\u003e were similarly comparable between the groups, with both showing early improvements in \u003cb\u003eQmax\u003c/b\u003e (POD-1: 20.5 vs. 19.9 mL/s). This finding is along the lines of reports by Gilling et al. (2008) for HoLEP and by Thomas et al. (2016) for KTP PVP[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. \u003cb\u003eDuration of hematuria\u003c/b\u003e was significantly shorter in the KTP group, which is in tangent with the superior coagulation profile previously described for photoselective vaporization (Te et al., 2008). Occurence of \u003cb\u003eacute urinary retention requiring re-catheterization\u003c/b\u003e, \u003cb\u003eclot retention\u003c/b\u003e, and \u003cb\u003efebrile episodes\u003c/b\u003e were low across both groups, indicating that perioperative hassles are acceptably low for both modalities.\u003c/p\u003e\u003cp\u003eOn follow up, both HoLEP and KTP laser vaporization demonstrated significant improvements in LUTS outcomes, as reflected by fall in the IPSS scores, increases in Qmax, fall in PVR, and improved voided volumes at follow-up. These findings are in line with previously published randomized trials and meta-analyses. Elzayat and Elhilali reported that HoLEP offers durable improvements in urinary symptoms and flow rates, with functional outcomes equivalent or superior to TURP.\u003c/p\u003e\u003cp\u003eIn our series, however, HoLEP showed superior outcomes at 6 months, with significantly \u003cb\u003elower IPSS\u003c/b\u003e and \u003cb\u003ePVR\u003c/b\u003e and higher Qmax and voided volume compared to KTP. This observation is supported by the randomized controlled trial by Bouchier-Hayes et al., which found that HoLEP resulted in greater improvements in flow rates and post-void residual urine than PVP at 6 and 12 months[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, a meta-analysis by Tan et al. concluded that HoLEP provides better functional durability than PVP, particularly in prostates of larger volume.\u003c/p\u003e\u003cp\u003eThe complication profile in our cohort was low and comparable between the two groups. \u003cb\u003eTransient dysuria\u003c/b\u003e was the most common adverse events, with no significant difference between HoLEP and KTP, echoing findings from earlier series. Importantly, the \u003cb\u003erisk of incontinence\u003c/b\u003e and \u003cb\u003esexual dysfunction\u003c/b\u003e remained minimal at the end of 6 months, proportioning with prior studies showing that both laser modalities preserve safety while achieving effective debulking of the adenoma .\u003c/p\u003e\u003cp\u003e\u003cb\u003eLong-term complication rates\u003c/b\u003e remained low, with no significant differences in bladder neck stenosis, urethral stricture formation, or residual urine volumes between the groups.\u003c/p\u003e\u003cp\u003eOur re-intervention rate was slightly higher in the KTP arm, a finding that has been variably reported in the literature \u0026mdash; with Malek et al. (2012) noting higher re-treatment needs for vaporization compared to enucleation in certain long-term series, possibly due to incomplete removal of adenomatous tissue in some cases.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOn side by side together, our results suggest that both HoLEP and KTP PVP provide proportionately similar clinical improvements and safety profiles with HoLEP providing better long-term functional outcomes and those with larger prostate glands with lower re-intervention rates as suggested by prior meta-analyses (Ahmed et al.2021) with KTP PVP offering a slight advantage in terms of reduced hemoglobin loss and shorter duration of hematuria.\u003c/p\u003e\u003cp\u003eLimitations of the present study was limited by its modest sample size and short follow-up, but the consistency of our findings with established literature establishes its validity. Extension of this pilot study along multicentre is needed further to probe and gauge the efficacy of these modalities.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBoth HoLEP and KTP PVP are safe, effective, and well-tolerated for prostates under 100 g, offering comparable functional improvements[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. KTP PVP was better in terms of reduced hemoglobin loss and shorter duration of hematuria, while HoLEP gives complete adenoma removal and potentially fewer future re-exploration[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. But ultimately, the choice of procedure should be governed on the basis of patient characteristics, surgical expertise, and available resources in the institute.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval: MKCG Medical College and Hospital, Berhampur\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Conflict of Interest: The authors declare no conflict of interest.\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent: Written informed consent was obtained from all participants.\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor, Co-Author - Data Collection, Tabulation, Interpretation and Research Article Writing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGilling PJ, Kennett KM, Das AK, Thompson D, Fraundorfer MR (2000) Holmium laser enucleation of the prostate (HoLEP) for glands larger than 100 g: an endourologic alternative to open prostatectomy. J Urol 164(3):971\u0026ndash;975\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalek RS, Kuntzman RS, Barrett DM (2000) High power potassium-titanyl-phosphate laser vaporization prostatectomy: 24 hours later. Urology 55(5):769\u0026ndash;772\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBachmann A, Sch\u0026uuml;rch L, Ruszat R et al (2005) Photoselective vaporization of the prostate: the Basel experience after 1000 cases. Eur Urol 47(6):798\u0026ndash;804\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuszat R, Seitz M, Wyler SF et al (2008) GreenLight laser vaporization versus transurethral resection of the prostate: 2-year results of a prospective randomized trial. Eur Urol 54(5):1058\u0026ndash;1066\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation and transurethral resection of the prostate: results at 7 years. Eur Urol 61(4):747\u0026ndash;754\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Gilling PJ (2010) A randomized trial of photoselective vaporization of the prostate vs holmium laser enucleation of the prostate: results at 2 years. BJU Int 105(7):964\u0026ndash;969\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalek RS, Barrett DM, Kuntzman RS (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344\u0026ndash;1348\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTan A, Liao C, Mo Z, Cao Y (2016) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate and photoselective vaporization of the prostate in the treatment of benign prostatic obstruction. BJU Int 117(4):614\u0026ndash;623\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed K, El Tayeb MM, Barod R et al (2021) Holmium laser enucleation versus photoselective vaporization of the prostate: systematic review and meta-analysis. J Endourol 35(9):1255\u0026ndash;1266\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\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":"","lastPublishedDoi":"10.21203/rs.3.rs-8134670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8134670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/u\u003e\u003cbr\u003e\nBenign prostatic hyperplasia (BPH) frequently affects ageing men, and surgical intervention is often required when medical therapy fails. Holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate photoselective vaporization (KTP PVP) are widely used minimally invasive options, yet comparative data in prostates \u0026lt;100 g remain limited.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/u\u003e\u003cbr\u003e\nTo compare perioperative outcomes, early recovery, and short-term functional results between HoLEP and KTP PVP in men with moderate-sized prostates (\u0026lt;100 g).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/u\u003e\u003cbr\u003e\nThis prospective, single-center randomized controlled trial included 60 men aged 50–80 years with symptomatic BPH (IPSS \u0026gt;12, Qmax \u0026lt;15 mL/s, prostate 40–100 g). Participants were randomized equally to HoLEP or KTP PVP. Outcomes assessed included intraoperative parameters, postoperative recovery, complications, and functional results (IPSS, Qmax, PVR, voided volume) at 1, 3, and 6 months.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/u\u003e\u003cbr\u003e\nBaseline demographics and symptom burden were comparable between groups.\u003cbr\u003e\nKTP PVP showed significantly lower hemoglobin drop (0.6 vs 1.1 g/dL, p \u0026lt; 0.001) and shorter duration of hematuria (1.6 vs 2.3 days, p \u0026lt; 0.01). Operative time was slightly shorter with KTP but not significant (p = 0.07).\u003cbr\u003e\nBoth procedures produced significant improvements in LUTS, flow rate, and PVR at all follow-up points.\u003cbr\u003e\nAt 6 months, HoLEP demonstrated superior functional outcomes: lower IPSS (6.0 vs 7.5, p = 0.04), higher Qmax (22.4 vs 19.6 mL/s, p = 0.03), lower PVR (28 vs 38 mL, p = 0.01), and higher voided volume (310 vs 280 mL, p = 0.04).\u003cbr\u003e\nComplication rates were low and similar. Re-intervention was needed in two KTP cases and none in HoLEP.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/u\u003e\u003cbr\u003e\nBoth HoLEP and KTP PVP are safe and effective for prostates \u0026lt;100 g. KTP offers advantages of reduced bleeding and faster early recovery, while HoLEP provides superior 6-month functional outcomes and fewer re-interventions. Procedure choice should be individualized based on patient profile, surgeon expertise, and resource availability.\u003c/p\u003e","manuscriptTitle":"Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume \u0026lt;100 g: A Pilot Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 19:25:52","doi":"10.21203/rs.3.rs-8134670/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":"036dee16-435b-46a6-b97f-4a6ec89855ff","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T07:55:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 19:25:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8134670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8134670","identity":"rs-8134670","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}