HoLEP vs. TURP in Elderly Patients: Insights into Recovery, Complications, and Risk Factors

Background: We compared the safety and efficacy of Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP) in elderly men (aged ≥75 years) with benign prostatic hyperplasia (BPH). Methods: A retrospective analysis of 151 patients (HoLEP: 72; TURP: 79) was conducted. Preoperative and postoperative parameters, including prostate size, International Prostate Symptom Score (IPSS), catheterization duration, hospital stay, and perioperative complications (incontinence and dysuria), were analyzed. Results: HoLEP significantly reduced catheterization (22 h vs. 50 h) and hospitalization times (1 d vs. 3 days) compared to TURP (p < 0.01). However, HoLEP was associated with longer operation times (81.89 min vs. 67.95 min; p < 0.01) and higher rates of dysuria (65.3% vs. 27.8%) and transient incontinence (27.8% vs. 8.9%; p < 0.001). Conclusion: HoLEP offers significant perioperative benefits over TURP, particularly in shortening recovery times; however, further investigation is required to address the higher rates of dysuria and incontinence. Although the retrospective design and surgeon experience constitute limitations, these findings underscore the need for prospective studies. The results support personalized surgical decision-making, emphasizing patient-specific factors such as BMI. These insights may help refine perioperative management and improve collaborative decision-making to enhance outcomes in elderly patients with BPH.