Is minimally invasive laser enucleation of the prostate a game changer? A propensity score-matched analysis comparing MILEP and holmium laser enucleation of the prostate.

INTRODUCTION: Laser enucleation of the prostate offers similar efficacy and safety outcomes as Transurethral Resection of Prostate (TURP) and open/ robotic-assisted simple prostatectomy. Recent technological progress has resulted in improved equipment design and the miniaturization of instruments in order to reduce urethral injury, friction and stricture rates. In this article we evaluated the safety, efficacy and complications of Minimally Invasive Laser Enucleation of Prostate (MILEP) and compared it with Holmium Laser Enucleation of Prostate (HoLEP). PATIENTS AND METHODS: A retrospective analysis was performed on the patients who underwent HoLEP and MILEP between March, 2022 and December, 2023 at our institute. These patients were followed up for a period of 6 months. The clinical demographic, perioperative and functional outcome data were compared. RESULTS: Propensity score matching yielded 137 patients in each study group. The median prostate size was similar; [55(42–74) cc] in HoLEP group vs. [54(40–70) cc (p = 0.442)] in the MILEP group. MILEP group had significantly less enucleation time: [ 34(25–40) mins vs. 38 (30–45) mins; p = 0.012)] and morcellation time [6(4–10) mins vs. 7(5–11) mins; p = 0.04]. HoLEP group had significantly higher dry weight of morcellated tissue [25(15–40) g vs. 20 (15–32); p = 0.03)]. Both modalities demonstrated similar enucleation efficiency; [(0.68 (0.42-1gm/min and 0.67 (0.43–0.91) gm/min, in HoLEP and MILEP respectively; p = 0.368)]. There was no significant difference in the incontinence rates at catheter removal and at 6 months [(10.2% vs. 9.5%; p = 0.839, and 1.5% vs. 0%; p = 0.498, respectively)], urethral stricture [(10.2% vs. 4.4%, respectively; p = 0.063] and bladder neck contracture rates [(1.5% vs. 2.9%, respectively; p = 0.684)]. CONCLUSION: MILEP demonstrated comparable efficacy and safety to HoLEP, allowing safe management of small and medium sized glands.