Surgical Outcomes of 108 Patients Undergoing Holmium Laser Enucleation of the Prostate Over Three Years in a Rural District General Hospital.

INTRODUCTION: An emerging method to treat benign prostatic hyperplasia (BPH) is Holmium Laser Enucleation of the Prostate (HoLEP). This study aims to evaluate the feasibility, safety, and functional outcomes of introducing a HoLEP service in a rural UK District General Hospital (DGH). METHODS: This was a retrospective study of 108 consecutive patients who underwent HoLEP between April 2022 and April 2025, performed by a single surgeon at a rural district general hospital. Perioperative parameters, histology, functional outcomes (International Prostate Symptom Score (I-PSS), quality of life (QoL), maximum urinary flow rate (Qmax), residual volume (RV), and prostate-specific antigen (PSA)), and complications (Clavien-Dindo classification) were analyzed. Nonparametric tests were used to compare preoperative and postoperative data; results are reported with mean differences and P values. RESULTS: Mean prostate volume was 104 mL, with a mean resected weight of 54 g and a mean operative time of 139 minutes. Significant postoperative improvements were observed across all functional domains: Qmax (+11 mL/s), RV (-196 mL), I-PSS (-12.6 points), QoL (-2.3 points), and PSA (-5.9 ng/mL), all p<0.001. Histology confirmed BPH in 88% and incidental prostate cancer in 7%. Limitations include incomplete follow-up and the absence of a comparator group. CONCLUSION: HoLEP can be delivered safely and effectively in a rural DGH, with substantial functional improvements and low rates of clinically significant complications. Broader dissemination of HoLEP beyond tertiary centers is feasible, but comparative and cost-effectiveness studies are required.