Comparative Study of HoLEP and KTP Photo selective Vaporization for Prostate Volume <100 g:  A Pilot Randomized Controlled Trial

Background: Benign prostatic hyperplasia (BPH) frequently affects ageing men, and surgical intervention is often required when medical therapy fails. Holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate photoselective vaporization (KTP PVP) are widely used minimally invasive options, yet comparative data in prostates <100 g remain limited. Objective: To compare perioperative outcomes, early recovery, and short-term functional results between HoLEP and KTP PVP in men with moderate-sized prostates (<100 g). Methods: This prospective, single-center randomized controlled trial included 60 men aged 50–80 years with symptomatic BPH (IPSS >12, Qmax <15 mL/s, prostate 40–100 g). Participants were randomized equally to HoLEP or KTP PVP. Outcomes assessed included intraoperative parameters, postoperative recovery, complications, and functional results (IPSS, Qmax, PVR, voided volume) at 1, 3, and 6 months. Results: Baseline demographics and symptom burden were comparable between groups. KTP PVP showed significantly lower hemoglobin drop (0.6 vs 1.1 g/dL, p < 0.001) and shorter duration of hematuria (1.6 vs 2.3 days, p < 0.01). Operative time was slightly shorter with KTP but not significant (p = 0.07). Both procedures produced significant improvements in LUTS, flow rate, and PVR at all follow-up points. At 6 months, HoLEP demonstrated superior functional outcomes: lower IPSS (6.0 vs 7.5, p = 0.04), higher Qmax (22.4 vs 19.6 mL/s, p = 0.03), lower PVR (28 vs 38 mL, p = 0.01), and higher voided volume (310 vs 280 mL, p = 0.04). Complication rates were low and similar. Re-intervention was needed in two KTP cases and none in HoLEP. Conclusion: Both HoLEP and KTP PVP are safe and effective for prostates <100 g. KTP offers advantages of reduced bleeding and faster early recovery, while HoLEP provides superior 6-month functional outcomes and fewer re-interventions. Procedure choice should be individualized based on patient profile, surgeon expertise, and resource availability.