Recurrence Rate of HOLEP vs TURP
HOLEP demonstrates superior long-term durability with significantly lower recurrence rates (1-1.5%) compared to TURP (5-15%), making it the preferred choice for patients prioritizing long-term outcomes and avoiding reoperation. 1
Reoperation Rates from High-Quality Evidence
The 2023 European Association of Urology guidelines establish that HoLEP demonstrates similar mid- to long-term efficacy to TURP, with meta-analyses showing comparable reoperation rates at 3 years (7.2% for HoLEP vs 6.6% for TURP, p=1.0). 2, 3
However, when examining recurrence specifically:
- TURP has an estimated recurrence rate of 5-15% for benign prostatic hyperplasia requiring reoperation. 1
- HoLEP results in much lower recurrence rates, not exceeding 1-1.5%, representing a 3-10 fold reduction compared to TURP. 1
Long-Term Durability Data
At 3-year follow-up, reoperation rates were equivalent between HoLEP (7.2%) and TURP (6.6%), though this includes all causes of reoperation (urethral strictures, bladder neck contractures, and BPH recurrence), not just recurrence alone. 3
The superior tissue removal with HoLEP explains the lower recurrence:
- HoLEP removes significantly more prostate tissue (40.4g vs 24.7g in one randomized trial), providing more complete adenoma removal. 4
- More complete enucleation with HoLEP removes entire prostatic lobes down to the surgical capsule, whereas TURP performs incomplete resection. 4, 1
Clinical Implications for Procedure Selection
For patients prioritizing long-term durability and minimal risk of requiring repeat surgery, HoLEP is the superior choice. 1, 5
Key considerations:
- Younger patients who face longer lifetime risk of recurrence benefit most from HoLEP's lower recurrence rate. 1
- Larger prostates (>80ml) particularly benefit from HoLEP's ability to completely enucleate all adenomatous tissue. 2, 4
- Patients with previous TURP failure can successfully undergo HoLEP for recurrent BPH with outcomes equivalent to primary HoLEP. 1
Important Caveats
The technical difficulty of HoLEP has limited its widespread adoption, with only 4-5% of BPH procedures being HoLEP compared to TURP remaining the most common procedure. 5
Surgeon experience significantly impacts outcomes, as HoLEP has a recognized learning curve that may affect early adoption. 6
Both procedures achieve similar symptomatic improvement at 12-36 months in terms of IPSS scores and maximum flow rates, so the primary advantage of HoLEP is durability rather than short-term symptom relief. 2, 3