Journal Article

Technological innovation of HoLEP: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Xu, Li, Ding, Yue, Du, Renji, Shen, Yajun, Sun, Zhiwei, Wang, Rong, Liu, Haiyong, Wang, Ping, Gu, Lijuan, Gao, Zhixiang

2025

Overview

Purpose The purpose of this study was to investigate the efficacy of Transurethral Holmium Laser of the Prostate (HoLEP) with Double-n Technology in the treatment of benign prostatic hyperplasia (BPH), with a focus on preserving sexual function postoperatively. Methods Conducted as a multicenter, prospective, single-blind randomized controlled trial, this study enrolled sexually active male patients with BPH. Participants were randomized into three groups: standard HoLEP (Group A), single-n technology (Group B), and innovative double-n technology (Group C), which emphasizes the preservation of the urethral mucosa and nearby structures. The primary endpoints included maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF). Results Of the 180 initial participants, 139 completed the study. All groups showed significant improvements in Qmax and IPSS. Initial declines in IIEF scores were noted across all groups, stabilizing to baseline by 3 months without further improvement. Group A had modest antegrade ejaculation rates, starting at 15.4% at 3 months and reaching 23.1% at 12 months. Group B showed a significant improvement, with AE rates rising from 31.8% at 3 months to 45.5% at 12 months, significantly higher than Group A ( p  < 0.05). Group C had the highest AE rates, starting at 57.8% at 3 months and reaching 77.8% at 12 months, significantly surpassing both Group A and B ( p  < 0.05). Regarding semen reduction, Group A had 100% reduction at 3 months, which decreased to 77.8% at 12 months. Group B followed a similar trend, from 100% at 3 months to 68.2% at 12 months. Group C showed a more pronounced decline, starting at 84.6% at 3 months and dropping to 37.1% at 12 months, with values significantly lower than both Groups A and B ( p  < 0.05). Conclusions The double-n HoLEP technique shows promising results in improving urinary symptoms while better preserving ejaculatory function and sexual quality of life in BPH patients. This technique could offer a significant advancement in the surgical management of BPH, particularly for sexually active patients.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Ejaculation / Humans / Hyperplasia / Lasers, Solid-State - therapeutic use / Lower Urinary Tract Symptoms - etiology / Lower Urinary Tract Symptoms - surgery / Male / Medicine / Medicine & Public Health / Middle Aged / Nephrology / Oncology / Prospective Studies / Prostate / Prostatic Hyperplasia - complications / Prostatic Hyperplasia - surgery / Quality of life / Single-Blind Method / Transurethral Resection of Prostate - methods / Treatment Outcome / Urinary tract / Urology