Contemporary Trends of Holmium Laser Enucleation of the Prostate (HoLEP) Utilization in the United States: A Comprehensive Analysis Using the National Surgical Quality Improvement Program (NSQIP) Database (2011-2020).

INTRODUCTION:The most recent American Urological Association Guidelines (AUA) advocated the utilization of laser enucleation of the prostate (LEP) as a size-independent surgical option for benign prostatic hyperplasia (BPH). Despite its endorsement by (AUA) and the growing body of evidence supporting its safety and efficacy, the utilization of LEP remains limited in the United States. This study aimed to evaluate the utilization trends and perioperative outcomes of LEP compared to other surgical procedures used for BPH management. METHODS:A retrospective cohort analysis was performed using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2011 to 2020. Patients undergoing prostatectomy for BPH were identified using specific current procedural terminology (CPT) codes. Baseline demographic data, preoperative risk factors, and postoperative outcomes were collected. Multivariable logistic regression was employed to assess predictors of holmium laser enucleation of the prostate (HoLEP) utilization and postoperative complications. RESULTS:Out of 8,415,549 patients, 95,144 underwent prostatectomy for BPH. Procedures included HoLEP 5,305 cases, transurethral resection of the prostate (TURP) 57,803 cases, Repeated TURP (re-TURP) 5,549 cases, photoselective vaporization of the prostate (PVP) 23,739 cases, and simple prostatectomy 2,748 cases. HoLEP utilization showed a gradual increase, from 4.8% in 2015 to 7.6% in 2020. Multivariable regression revealed that HoLEP selection significantly increased from 2016-2020 (OR: 1.251, p < 0.001), and there was less likelihood of HoLEP selection for African American patients (OR: 0.752, p < 0.001). HoLEP had significantly lower complication rates, including UTIs, blood transfusions, 30-day re-admission, and reoperation. CONCLUSION:Despite underutilization, the adoption of HoLEP slightly increased since 2015, possibly due to recommendations by the AUA. Factors such as race influence its adoption, while age, diabetes, bleeding disorders, and functional dependence showed limited influence.