Lessons learned from our preliminary experience with MiLEP: a retrospective analysis of efficacy and safety using slim and ultra-slim instruments.

purposeMinimally invasive laser enucleation of the prostate has emerged as a promising treatment for benign prostatic hyperplasia. This study investigates the efficacy and safety of miniaturized holmium laser enucleation of the prostate (MiLEP) using Slim (22 Fr) and Ultra-Slim HoLEP (18.5 Fr).

methodsWe retrospectively analyzed 84 patients who underwent MiLEP between February 2022 and October 2023, performed by a single experienced surgeon. Thirteen patients were treated with Ultra-Slim HoLEP, and 71 with Slim HoLEP. Perioperative parameters, functional outcomes, and complications were assessed intraoperatively and at 2, 6, and 12 weeks postoperatively.

resultsMedian patient age was 62 [IQR 60-72] and 72 [IQR 65-77] years in the Ultra-Slim and Slim groups, respectively. The median prostate volume was 45 ml [IQR 35-65] and 65 ml [IQR 50-90], with similar median enucleation weights (36 g vs. 35 g). No urethral strictures were observed at three months. Continence rates at 12 weeks reached 100% in the Ultra-Slim group and 95.6% in the Slim group. Perioperative efficiency, including total operation time and laser energy use, was comparable between the groups despite differences in prostate volume.

conclusionMiLEP using Slim and Ultra-Slim instruments provides a safe and effective alternative to standard HoLEP (≥ 26 Fr), demonstrating favorable postoperative continence and a low complication profile. The findings suggest potential benefits of miniaturized instruments in reducing urethral trauma while maintaining enucleation efficiency. Further prospective studies are warranted to validate these results and explore long-term outcomes.