Holmium laser enucleation of the prostate (HoLEP) has steadily emerged as the definitive endoscopic surgical option for BPH, offering complete adenoma removal akin to open prostatectomy but through a minimally invasive approach. Early scepticism regarding HoLEP centred around its perceived learning curve and technical demands. However, as experience grew and longer-term data accumulated, it became evident that HoLEP provided excellent functional outcomes and durability.
Our recent systematic review comparing long-term outcomes (≥5 years) of HoLEP and GLPVP provides the most compelling evidence that HoLEP is superior in sustained symptom relief and lower reoperation rates. While GreenLight delivers effective short-term results, its long-term efficacy beyond five years has remained an open question. This study provides a clear answer: HoLEP outperforms GLPVP in durability.
The data showed that HoLEP had consistently low reoperation rates, averaging just 4.1% at a mean follow-up of 7.3 years. In contrast, in some studies, reoperation rates for GLPVP were considerably higher, with figures exceeding 12%. While advances in GreenLight technology, such as the transition from 80W to 180W systems, have improved outcomes, they have not yet bridged the gap in long-term efficacy compared to HoLEP.
These findings reinforce a shifting paradigm in surgical BPH laser treatments. For decades, clinicians have had to balance proficiency and patient safety with concerns about durability. With this growing body of evidence, HoLEP has cemented itself as the standard of care for long-term outcomes.
While GreenLight remains an essential tool in the urologic armamentarium, particularly for select patient populations, these results highlight the need to counsel patients on the long-term durability of HoLEP. As urologists, our goal should always be to offer patients the best evidence-based treatment, and the evidence seems clear: HoLEP stands out as the more durable endoscopic laser surgical option for BPH.
Written by:
- Kapil Sethi, Department of Urology, Austin Health Heidelberg, Victoria, Australia.
- Matt Alberto, Department of Urology, Austin Health Heidelberg; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.