World Journal of Urology
HoLEP provides a higher prostate cancer detection rate compared
to bipolar TURP: a matched‑pair analysis
· Eva M. Lausenmeyer
· Roman Mayr
· Maximilian Burger
· Christian Eichelberg
Received: 20 February 2018 / Accepted: 25 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Holmium laser enucleation of the prostate (HoLEP) has become a popular alternative to TURP for desobstructive
prostate surgery. The prevalence of incidental prostate cancer (iPCa) during surgery varies depending on many preoperative
factors. To evaluate whether the surgical procedure itself (HoLEP vs. TURP) inﬂuences iPCa detection, we performed a
case-by-case matched-pair analysis.
Methods Preoperative patient age, total PSA, and prostate volume were used as matching criteria. Descriptive statistics
were used to conﬁrm matching quality. Parameters were analyzed by Fisher’s exact test and T test or Mann–Whitney U test
for dichotomous and continuous variables, respectively. Uni- and multivariate logistic regression analyses were performed
to identify predictors for iPCa detection.
Results 60 out of 136 patients after HoLEP and 60 out of 1220 patients after bipolar TURP (bTURP) could be included.
Mean patient age was 71.5 and 70.3 years in the HoLEP and bTURP group, respectively. Median preoperative total PSA
was 4.42 ng/ml for HoLEP and 4.33 ng/ml for bTURP patients. Median preoperative prostate volume was 75.0 cc in both
groups. Mean percentage of tissue removed by HoLEP and bTURP was 63.5 and 49.5% (p < 0.001), respectively. IPCa
was found in 23.3% of HoLEP specimens compared to 8.3% in bTURP (p = 0.043). PSA density was the only independent
predictor for iPCa detection.
Conclusions In this ﬁrst matched-pair analysis, HoLEP provides a signiﬁcantly higher iPCa detection rate than bTURP. This
might be a result of a more eﬃcient tissue removal during HoLEP. PSA density was the only independent risk factor for iPCa.
Keywords Bipolar TURP · HoLEP · Incidental prostate cancer · Matched pairs
Surgical therapy of lower urinary tract symptoms (LUTS)
due to bladder outlet obstruction (BOO) caused by benign
prostatic enlargement (BPE) is required when medical ther-
apy fails to resolve symptoms or in the presence of absolute
indications for desobstruction. For many years, TURP and
open prostatectomy have been considered as the reference
procedures depending on preoperative prostate volume.
In the past years, however, Holmium laser enucleation of
the prostate (HoLEP) has gained popularity as it has been
demonstrated to be at least as eﬀective as TURP regarding
functional outcomes [1, 2]. In contrast to TURP, HoLEP
enables complete anatomical enucleation of the lobes by
dissecting the adenoma along the prostatic pseudocapsule.
Afterwards, the lobes are dropped back into the bladder
while still intact, fragmented and retrieved by a morcellator.
In this context, HoLEP has been proven to be prostate-
size independent  which makes it a less invasive alterna-
tive to open surgery with reduced morbidity [4, 5]. Thus, the
current European Association of Urology (EAU) guideline
recommends HoLEP as the ﬁrst choice for surgical treat-
ment of prostates > 80 cc and as an alternative to TURP for
prostate volumes between 30 and 80 cc .
During preoperative consultation, the subject of con-
comitant prostate cancer and its probability is regularly
raised. Screening for prostate cancer, however, is currently
one of the most controversial topics in the urological lit-
erature and the EAU guideline recommends screening only
by a risk-adapted strategy to well-informed men with a
* Bernd Rosenhammer
Department of Urology, Caritas St. Josef Medical
Center, University of Regensburg, Landshuter Str. 65,
93053 Regensburg, Germany