Holmium Laser Enucleation of the Prostate (HoLEP) With Proactive Preservation of One Lateral Lobe: A Technique for Benign Prostatic Hyperplasia to Preserve Sexual Function.

PURPOSE: This study aims to investigate the effects of holmium laser enucleation of the prostate (HoLEP) with proactive preservation of one lateral lobe (PLL-HoLEP) on urinary function and sexual function in patients with benign prostatic hyperplasia (BPH).

METHODS

From April 2024 to April 2025, 71 patients who underwent PLL-HoLEP (Group A) were studied based on inclusion and exclusion criteria. Meanwhile, 140 patients who underwent traditional HoLEP from September 2022 to March 2024 were selected as the control group (Group B). After propensity score matching (PSM) was performed, the baseline characteristics of the two groups were balanced. Subsequently, differences in clinical outcomes between the groups were compared. We compared preoperative and postoperative complications, international prostate symptom score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), postvoid residual urine (PVR), International Index of Erectile Function (IIEF-5), QMSHQ EjF, and QMSHQ EjS between the two groups, and conducted follow-up evaluations of surgical outcomes and sexual function.

RESULTS

Fifty-four pairs of patients were successfully matched by PSM. Operative time, resected prostate weight, hemoglobin decrease, and incidence of transient incontinence and retrograde ejaculation in Group A were lower than those in Group B. There were significant differences in IPSS, QoL, Qmax, and PVR between preoperative and 1 month postoperative periods in two groups (p < 0.05). However, there were no statistically significant differences in IPSS, QoL, Qmax, and PVR between the two groups at one and 6 months postoperatively (p > 0.05). Significant differences in IIEF-5, QMSHQ EjF, and QMSHQ EjS scores were observed between the two groups during the 6-month postoperative follow-up of sexual function (p < 0.05), with Group A showing better outcomes.

CONCLUSION

For patients who satisfy the inclusion and exclusion criteria, PLL-HoLEP can reduce the incidence of transient urinary incontinence and retrograde ejaculation and more effectively preserve the sexual function of patients with BPH.