Challenges of Salvage Holmium Laser Enucleation of the Prostate Following Contemporary Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: A Mixed-Methods Systematic Review with Meta-Analysis
Abstract
Background/Objectives: Contemporary minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia carry retreatment rates up to 32%, with holmium laser enucleation of the prostate (HoLEP) increasingly used as salvage therapy. Prior reviews focused on salvage HoLEP (sHoLEP) following transurethral resection; however, technical challenges specific to the post-MIST field remain uncharacterised. We aimed to characterise technical barriers during sHoLEP following contemporary MISTs, with secondary evaluation of efficacy, safety and feasibility. Methods: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines (PROSPERO: CRD420261321711), five databases were searched from inception to February 2026. Studies reporting sHoLEP outcomes in adults with prior MIST were included. Qualitative findings were synthesised thematically; quantitative outcomes reported by three or more studies underwent random-effects meta-analysis. Risk of bias was assessed using methodological index for non-randomized studies methodological index for non-randomized studies (MINORS) and certainty of evidence using grading of recommendations, assessment, development, and evaluation (GRADE). Results: Ten studies (354 sHoLEP, 3618 primary HoLEP (pHoLEP) patients) were included. Technical difficulty was MIST-type dependent: thermoablative procedures and prostatic artery embolisation preserved the enucleation plane, while prostatic urethral lift (PUL)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Treatment of non-metastatic castration-resistant prostate cancer: facing age-related comorbidities and drug–drug interactions
- The Efficacy of Flogofilm® in the Treatment of Chronic Bacterial Prostatitis as an Adjuvant to Antibiotic Therapy: A Randomized Prospective Trial
- Inhibition of growth and contraction in human prostate stromal cells by silencing of NUAK1 and -2, and by the presumed NUAK inhibitors HTH01-015 and WZ4003
- Effectiveness and Safety of a New Nutrient Fixed Combination Containing Pollen Extract Plus Teupolioside, in the Management of LUTS in Patients with Benign Prostatic Hypertrophy: A Pilot Study
- Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study
- Aquablation vs. holmium laser enucleation of the prostate for benign prostatic hyperplasia: a 150-patients prospective comparative multicenter study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.