Optimizing Laser Settings for Holmium Laser Enucleation of the Prostate: A Randomized Controlled Trial
In brief
Three laser frequencies produced similar surgery times and recovery after prostate enucleation
In a randomized trial of 319 patients, using 2-joule laser pulses at 40, 50, or 60 hertz led to similar surgery duration, symptom improvement, recovery, and complications over three months. Higher frequencies used more energy, and six operations required a switch to 60 hertz for better bleeding control; incomplete daily surveys in nearly one-quarter of patients limit the recovery data.
- Journal
- Journal of endourology (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jenny Guo, Jack T Peterson, Amir Patel, Jodhel Destina, Perry Xu, Nabila Khondakar, et al.
- PMID
- 42969923
- DOI
- 10.1177/08927790261502954
Why clinicians should know about it
- Picked for Urology (top studies of the week, 8 November 2026): Randomized trial compares HoLEP laser settings and recovery outcomes
Abstract
INTRODUCTION: Studies validating the optimal high-power laser energy settings for holmium laser enucleation of the prostate (HoLEP) are lacking. The goal of our study is to determine if different laser settings during HoLEP influence operative time primarily and postoperative symptoms and complications secondarily. METHODS: From March 2024 to April 2025, patients undergoing HoLEP with prostate measurements <200 mL were randomized 1:1:1 to laser energy settings of 2 Joules and 40, 50, or 60 Hertz (Hz) (NCT06531473). A high-power 120-watt holmium laser with pulse modulation was used for all patients. Patients were followed for 3 months postoperatively with daily surveys until day 14, surveys every third day until day 30, and then monthly thereafter until day 90. Postoperative outcomes were manually charted. RESULTS: Out of 341 patients screened, 319 consented for the study, and 76 (23.8%) did not complete their daily surveys. There were no significant differences in baseline characteristics. Surgery duration was similar in all groups, but energy usage was significantly higher with increased frequency settings (p < 0.001). Laser settings were changed from 40 Hz to 60 Hz in five cases and from 50 Hz to 60 Hz in one case due to inadequate coagulation effect. Patient-reported time to resolution of dysuria, difficult urination, incontinence, hematuria, and resumption of normal activity did not differ between cohorts (p > 0.05). There were no differences in emergency room visits related to HoLEP (p = 0.8). There was no difference in the change of IPSS or Michigan Incontinence Symptom Index scores between groups. CONCLUSION: Overall, there is no significant difference in the operative times and postoperative complications with the 2 J 40 Hz, 2 J 50 Hz, and 2 J 60 Hz laser settings for HoLEP, affirming the broad safety and efficacy of the procedure across diverse energy configurations.
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.