Sexual Outcomes and Symptom Relief Following HoLEP Versus BipoLEP: A Prospective Cohort Study

Objective: To prospectively compare the effects of Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (BipoLEP) on erectile function and lower urinary tract symptom (LUTS) outcomes in men undergoing surgery for benign prostatic hyperplasia (BPH). Methods: In this two-center prospective observational study, sexually active men with BPH and significant LUTS refractory to medical therapy underwent either HoLEP or BipoLEP performed by high-volume surgeons. Preoperative assessment included International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), prostate-specific antigen (PSA), prostate volume, body mass index (BMI), and International Index of Erectile Function-5 (IIEF-5). Erectile function was evaluated at 3, 6, and 9 months postoperatively, while LUTS outcomes were assessed at 3 months. Prostate cancer was excluded in all participants prior to surgery. Between-group and within-group analyses were performed using appropriate statistical tests. Results: A total of 140 patients were included (HoLEP: n = 74; BipoLEP: n = 66). Both procedures significantly improved IPSS and Qmax, with no postoperative differences between groups. HoLEP demonstrated stable erectile function across follow-up, with minimal deviation from baseline IIEF-5 scores. In contrast, BipoLEP produced a significant transient decline in erectile function at 3 months, followed by gradual recovery at 6 and 9 months, ultimately returning to preoperative levels. This early postoperative decline is likely associated with greater thermal dispersion inherent to bipolar electrosurgical energy. Conclusion: HoLEP and BipoLEP yield comparable LUTS improvement and long-term preservation of erectile function. However, BipoLEP is associated with a temporary early decline in IIEF-5 scores, whereas HoLEP offers more stable sexual outcomes throughout follow-up. These findings highlight important functional nuances that may guide individualized procedure selection in the surgical management of BPH.