Clinical outcomes of en-bloc non-lifting anatomical enucleation in day-case laser surgery for benign prostatic hyperplasia: a comparative study of HoLEP and ThuLEP

Objective: The study aimed to compare the efficacy, perioperative outcomes, and safety of en-bloc non-lifting anatomical laser enucleation using holmium (HoLEP) and thulium (ThuLEP) systems in a day-case setting, and to evaluate its feasibility for ambulatory management of benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed on 127 consecutive patients who underwent day-case en-bloc non-lifting laser enucleation for BPH from January 2022 to July 2025. Patients with prior prostate or urethral surgery, or ongoing antiplatelet therapy were excluded. Perioperative parameters, including operative time, enucleated tissue weight, hemoglobin reduction, catheterization time, and complications (classified by the Clavien–Dindo system), were recorded. Postoperative follow-up was conducted at 2, 6, and 12 weeks. Statistical analyses were performed using SPSS version 26.0, with p < 0.05 indicating significance. Result: A total of 67 HoLEP and 60 ThuLEP procedures were performed using the en-bloc non-lifting anatomical technique. The two groups were comparable in baseline characteristics. Operative time and hemoglobin decrease were similar between groups, although the mean resected tissue weight was significantly greater in the HoLEP group (p < 0.01). Postoperative recovery was rapid, with 85.0% of patients discharged within 24 hours and 95.3% within 48 hours; catheter removal was achieved in 67.7% on postoperative day 1 and in 97.6% by day 3. The overall perioperative complication rate was 11.8%, with no severe adverse events, and no significant difference between the two laser systems (p > 0.05). Both procedures resulted in substantial functional improvement, as reflected by significant reductions in IPSS and QoL scores and a more than threefold increase in Qmax (all p < 0.01). Conclusion: The en-bloc non-lifting anatomical laser enucleation technique offered a safe, efficient, and anatomically precise solution for day-case BPH surgery, achieving rapid recovery and comparable results with both holmium and thulium lasers.