To compare the efficacy and safety of low-power holmium laser enucleation (LP-HoLEP) and plamakinetic resection of prostate (PKEP) in treatment of patients with median volume of BPH.

104 patients with median volume BPH (30 ml<V<80 ml) and underwent LP-HoLEP (n=51) or PKEP (n=53) between June 2018 and June 2020 in our hospital were analyzed. All patients were followed up for 6 months. The age, Hb, V₁, RUV, IPSS score, Q_max, PSA, time of enucleation, morcellaction, bladder irrigation, indwelling catheter, hospital stay, weigh of excised gland and decrease of postoperative hemoglobin were comparatively analyzed. The increase number of cases of urinary leukocytes before and 7 d, 14 d and 21 d after surgey, and IPSS score, PSA and V₂ at 6 months after surgey in two groups were statistically analyzed.

There was no significant difference in preoperative data, included age, Hb, prostate volume, IPSS, Q_max, PSA and RUV between two groups (P>0.05). There was also no significant difference in enucleation and comminution time, weigh of excised gland, and decrease of hemoglobin between the two groups (P>0.05). However, LP-HoLEP was significantly superior to PKEP in terms of bladder irrigation time [(42.63±13.25) min vs (51.67±11.65) min] and indwelling catheter time [(1.80±0.56) d vs (2.23±0.83) d]. It can also reduce slightly hospital stay [(2.90±0.70) d vs (3.58±0.68) d], P<0.05. The increase number of cases urinary leukocytes changed with time before and 7 d, 14 d and 21 days after operation (F=132.842, P<0.05). And there was no significant difference in urinary leukocytosis between the two methods. The results were significantly improved compared with preoperative IPSS, PSA and postoperative prostate volume (P<0.05), but there was no statistical difference in complications include urinary incontinence, urinary tract infection, retrograde ejaculation and urethral stricture and so on during 6 months follow-up.

LP-HoLEP and PKEP can effectively enucleate the prostate and significantly improve the patient's LUTS symptom during 6-month follow-up. Both procedures reduced the patient's IPSS and PSA but showed no significant difference. LP-HoLEP and PKEP are significant effective and safe in moderate BPH. LP-HoLEP group had a slightly shorter indwelling catheter time, hospital stay and less flush fluid volume despite longer learning curve. In conclusion, LP-HoLEP is as well technically feasible, safe and as it can be further promoted.