Comparative Neurocognitive Outcomes Following Holmium Laser Enucleation and Transurethral Resection of the Prostate: A Prospective Cohort Study

Benign prostatic hyperplasia (BPH) is a common condition among aging men and is one of the most frequent causes of lower urinary tract symptoms. When symptoms become moderate to severe and do not respond adequately to medical therapy, surgical treatment is recommended. Transurethral resection of the prostate (TURP) has long been considered the standard surgical approach for BPH, while Holmium Laser Enucleation of the Prostate (HoLEP) has emerged as an effective minimally invasive alternative with favorable perioperative outcomes.

Although these procedures are widely used and generally considered safe, concerns remain regarding potential postoperative cognitive changes, particularly in elderly surgical populations. Postoperative cognitive dysfunction has been described after various surgical procedures and may affect patient recovery, functional independence, and quality of life. However, limited data are available regarding cognitive outcomes after BPH surgery, and direct comparisons between different surgical techniques remain scarce.

Most previous studies assessing cognitive outcomes after urological surgery have relied on the Mini-Mental State Examination (MMSE), which may have limited sensitivity in detecting mild cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a more sensitive tool that evaluates multiple cognitive domains including executive function, attention, memory, language, and visuospatial ability.

This prospective observational cohort study aims to compare postoperative cognitive trajectories in patients undergoing HoLEP or TURP for symptomatic BPH. Eligible patients will undergo standardized cognitive and psychological assessments before surgery and three months postoperatively. The primary outcome is the change in MoCA score over time. Secondary outcomes include changes in MMSE, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) scores.

Statistical analyses will evaluate longitudinal changes in cognitive outcomes and investigate whether surgical technique independently influences postoperative cognitive performance after adjustment for potential confounding factors such as age and educational level.