A comparative observational prospective study to assess outcome in monopolar transurethral resection of the prostate (turp) vs holmium laser enucleation of the prostate (holep) in benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is most common causes of lower urinary tract symptoms (LUTS) in ageing male, with significant impact on quality of life. Surgical management is indicated in patients with severe symptoms, complications, and failure of medical management. Monopolar transurethral resection of the prostate (mTURP) has long been considered the gold standard surgical treatment, offering proven efficacy in relieving LUTS in BPH. However, mTURP is associated with some limitations such as perioperative bleeding, risk of TUR syndrome, and reduced efficiency in very large prostates.

Holmium laser enucleation of the prostate (HoLEP) is a novel, minimally invasive technique that uses the Holmium:YAG laser to enucleate the adenoma, followed by intravesical morcellation. HoLEP can be applied to all sizes prostates, uses saline irrigation (avoiding TUR syndrome), and is associated with reduced blood loss, shorter catheterisation time, and shorter hospital stay. Despite these advantages, its adoption is limited by high equipment costs, a steep learning curve, and limited availability. There is limited study on moderate size prostate glands which is most seen in BPH.

This prospective comparative study aims to evaluate and compare perioperative parameters, functional outcomes, complication rates, and patient satisfaction between mTURP and HoLEP in patients with BPH. Eligible patients will be allocated to either surgical group and followed up for 1 year. Data will be analysed to determine differences in symptom improvement, flow rate changes, hospitalisation duration, and postoperative complications. The findings of this study are expected to provide evidence-based insights into the relative merits of these two surgical modalities, helping guide clinical decision-making and optimising patient care in the context of both traditional and evolving urological practice.