To compare the safety and efficacy between transurethral bipolar plasmakinetic prostatectomy (TUPKP) and holmium laser enucleation of the prostate (HoLEP) for the treatment of large-size (>80 ml) BPH.

In Foshan Fosun Chancheng Hospital, from January 2017 to January 2021, patients of BPH, prostate size >80 ml, were enrolled in this randomised controlled study, which were classified as TUPKP group (37 patients) and HoLEP group (35 patients). IPSS, QOL, Q_max and RUV were assessed preoperatively and postoperatively at 1 and 6 months between the two groups. Operative time, blood loss, catheterization duration, postoperative hospital stay and complications were all recorded.

Surgeries were successfully achieved in one stage in all patients. Perioperative results showed that operative time was significantly shorter in HoLEP group as well as catheterization duration and postoperative hospital stay (P<0.05, respectively), while there was no statistical difference between the two groups in terms of postoperative bladder irrigation. The prostate tissue removed in the HoLEP group was more than that in the TUPKP group (P<0.05), and the blood loss was less in the HoLEP group (P<0.05). The IPSS, RUV and QOL in each group at 1 month and 6 months were significantly lower than those before operation (P<0.05), meanwhile, Q_max of the two groups were significantly higher than those before operation (P<0.05). The improvement of IPSS and QOL were more obvious at 1 month in the HoLEP group (P<0.05, respectively). However, there were no significant difference between the two groups in IPSS, Q_max, RUV and QOL at 6 months (P>0.05). There was no significant difference in the incidence of intraoperative and postoperative complications between the two groups (P>0.05).

HoLEP and TUPKP are both safe and effective for the treatment of large-size benign prostatic hyperplasia. Compared to TUPKP, HoLEP provides a superior operative efficiency and bleeding control, it needs shorter catheterization duration and hospital stay.