HoLEP Versus Mini-HoLEP: A Long-term Follow-up Prospective Randomized Controlled Trial
In brief
Mini-HoLEP cuts one-month urinary leakage from 51% to 22% in trial
In a randomized trial of 90 men, urinary leakage at one month was reported by 22% after mini-HoLEP, compared with 51% after standard HoLEP. The gap persisted at two months, but long-term leakage rates were low and did not differ significantly after a median 828 days. The trial supports faster early continence recovery, though it was small and involved one surgeon.
- Journal
- European urology open science (Q1)
- Published
- 8 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Tomer Mendelson, Omri Schwarztuch Gildor, Ziv Savin, Tarek Taha, Itamar Confino, Tomer Bashi, et al.
- PMID
- 42892994
- DOI
- 10.1016/j.euros.2026.09.010
Why clinicians should know about it
- Picked for Urology (paper of the day, 19 October 2026): MiLEP improves early continence recovery, supporting miniaturization
Abstract
BACKGROUND AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is increasingly performed with miniaturized instruments, aiming to reduce postoperative urinary incontinence (UI). Evidence for mini-HoLEP (MiLEP) using a 22-Fr resectoscope remains largely retrospective or nonrandomized. We aimed to compare MiLEP with a standard 26 Fr HoLEP in a prospective randomized trial. METHODS: Ninety men were randomized to MiLEP (n = 45) or HoLEP (n = 45). All procedures were performed by one surgeon using a standardized technique. The prespecified primary end point was UI, defined as any reported loss of urine, at 1 mo. Key secondary end points included UI at 2 mo and at the end of follow-up. KEY FINDINGS AND LIMITATIONS: Median follow-up was 828 days. UI at 1 mo was lower after MiLEP than HoLEP (22.2% vs 51.1%; odds ratio [OR] 0.27; 95% confidence interval [CI] = 0.11-0.67; p = 0.004). UI at 2 mo was also lower (8.9% vs 24.4%; OR 0.30; 95% CI = 0.09-0.99; p = 0.048), whereas long-term UI did not differ significantly (2.2% vs 6.7%; p = 0.61). MiLEP also lowered the need for meatal dilation (15% vs 51%; p < 0.001), irrigation volume (16 vs 24 l; p < 0.001), and improved core temperature maintenance (+0.1 °C vs -0.1 °C; p < 0.001), with higher median enucleation efficiency (1.22 vs 1.0; p = 0.003) and not statistically different operative time, complications, and functional improvement. Limitations include the inability to blind the surgeon and limited power for uncommon events. CONCLUSIONS AND CLINICAL IMPLICATIONS: MiLEP seems to improve early continence recovery, supporting miniaturization as a strategy to enhance patient-centered outcomes after HoLEP.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.