Minimally invasive laser enucleation of the prostate (MiLEP) is feasible and safe: 12-month follow-up, real-life, prospective multicenter study

Background Minimally invasive surgical therapies have transformed the management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction. Holmium laser enucleation of the prostate (HoLEP) is considered the gold standard for men with bothersome LUTS. HoLEP is performed with 26Ch instruments, which can cause urethral trauma, strictures, transient incontinence. Recent miniaturised 22Ch tools (MiLEP) aim to reduce morbidity without compromising efficacy. Methods This prospective multicenter study enrolled 65 men with BPH/BPO undergoing MiLEP. Preoperative assessment included IPSS, uroflowmetry, PSA, prostate volume and urinary continence. The MiLEP were performed en-bloc with early apical release. Follow-up assessed subjective and objective outcomes together with complications and patient satisfaction. Clinical success was defined as Trifecta. Logistic regression evaluated predictors of success. Results Mean age was 68,3 years and mean operative time was 82 minutes. Mean resected tissue weight was 42,6g. No major intraoperative complications occurred; median catheterisation and hospital stay were 2 and 2 days, respectively. Overall complication rate was 18,4%, mostly Clavien–Dindo grade I–II. Late complications were urethral stricture in 4,6% and persistent stress incontinence in 1,5%. At 12months, mean IPSS, IPSS QoL, Qmax, PSA significantly improved (all p < 0,001). Overall satisfaction was very high (97% “much or very much improved”). Trifecta was achieved in 61,5% of cases. Logistic regression identified lower pre operative Qmax as the only predictor of Trifecta achievement; prostate volume, age and resected tissue weight were not significant. Conclusions MiLEP is a safe and effective alternative to conventional HoLEP. Significant improvements in symptom scores, flow rate and PSA were sustained at 12 months with low morbidity and high continence preservation. These findings suggest that MiLEP may expand the benefits of enucleation to patients who might otherwise face higher complication risks. Larger trials and longer follow up are needed to confirm our data.