To compare the outcomes of ambulatory miniaturized holmium laser enucleation of the prostate (MiLEP) performed with a slim 22-F sheath versus standard holmium laser enucleation of the prostate (HoLEP) with a 26-F sheath.

We included 82 patients in this ongoing randomized controlled trial (RCT) who underwent endoscopic enucleation of the prostate (EEP) with either 22-F MiLEP or standard 26-F HoLEP between April and September 2024. Patients' preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes, including hospital admission and readmission rates, as well as measures such as IPSS, QoL, Qmax, PVR, and postoperative PSA, were collected and analyzed at 1- and 3-month follow-up intervals.

Of the 82 patients in the study, 41 underwent 22-F MiLEP, and 41 were managed with 26-F HoLEP. There were no statistically significant differences in preoperative characteristics between the two groups. Additionally, no significant differences were observed between the cohorts in terms of enucleation time, morcellation time, resected weight, or enucleation and morcellation efficiency. However, significant differences were observed in favor of the 26-F sheath regarding the duration of postoperative hematuria, catheterization time, and length of hospital stay. Approximately 29.3% of patients in the 22-F sheath group were admitted with immediate postoperative hematuria, compared to 9.8% in the 26-F sheath group (p=0.026). Patients treated with 26-F HoLEP were more likely to achieve a successful same-day trial of void (TOV), with rates of 89.2% and 62.1% in the 26-F and 22-F groups, respectively (p=0.009). Postoperative outcomes, including IPSS, QoL, Qmax, PVR, and postoperative PSA, were comparable between the two cohorts up to 3 months after surgery.

Both the 22-F and 26-F sheaths achieve satisfactory intraoperative and postoperative functional outcomes in EEP. However, 26-F HoLEP facilitates same-day trial TOV and reduces postoperative hospital admission rates.