Introduction: The purpose of this study was to evaluate the efficacy and safety of HoLEP in patients with benign prostatic hyperplasia (BPH) at a single institution. Methods: From August 2008 to June 2022, the baseline demographics, and post-operative follow-up results were retrospectively analyzed through EMR review. Patients were followed up at 2 weeks (n=2,997), 3 months (n=2,199), and 6 months (n=1,853) postoperatively under a critical pathway. Then, they were on open follow-up. Results: A total of 3,000 patients (mean age 69.6 ±7.7 years) underwent HoLEP. Mean total prostate volume was 67.9 (±34.2)ml and the baseline total IPSS score and the quality of life score were 19.3 (±7.7) and 3.9 (±1.1), respectively. The preoperative maximum flow rate (Qmax) was 9.4 (±4.8)ml/s, and the postvoid residual urine (PVR) volume was 77.8 (±97.6)ml. The total operation time was 60.7 (±31.6) minutes, and the catheter time was 1.3 (±1.2) day. Complications within 2 weeks postoperatively included re-catheterization in 110 patients (3.7%), blood transfusion in 19 patients (0.6%), transurethral coagulation (TUC) in 16 patients (0.5%), stress urinary incontinence (SUI) in 215 (mild 204; severe 11) patients (7.2%), urgency urinary incontinence (UUI) in 174 (mild 129; severe 45) patients (5.8%). Complications at 3 months postoperatively were SUI in 128 (mild 109; severe 19) patients (5.8%), UUI in 113 (mild 74; severe 39) patients (5.1%). Complications at 6 months postoperatively included SUI in 36 (mild 34; severe 2) patients (1.9%), UUI in 25 (mild 17; severe 8) patients (1.3%), bladder neck contracture in 15 patients (0.8%), de novo prostatic fossa stone in 11 patients (0.6%), and urethral stricture in 29 patients (1.5%). A total of 61 patients (2.0%) required secondary surgery (TUC 16, 0.5%; TUI for BNC 16, 0.5%; removal of prostatic fossa stones 11, 0.4%; EIU for urethral stricture 18, 0.6%;). At 3 months postoperatively, the total IPSS score was 7.9 (±5.9), Qmax was 21.8 (±11.6)ml/s, and the PVR volume was 21.0 (±38.1)ml. At 6 months postoperatively, the total IPSS score was 6.6 (±5.8), Qmax was 22.2 (±11.3)ml/s, and the PVR volume was 19.7 (±36.8)ml. Conclusions: Our mid-term follow-up results after HoLEP in BPH patients showed excellent efficacy and low complications. Unlike other previous reports, the incidence of SUI and UUI after HoLEP was low, but the occurrence of de novo stone formation in the prostatic fossa was notable. SOURCE OF Funding: None
