Jenny Guo, MD, discusses outcomes with hemi-HoLEP after pelvic radiation

In this video, Jenny N. Guo, MD, highlights findings from a retrospective propensity-matched study evaluating hemi-holmium laser enucleation of the prostate (hemi-HoLEP) as a treatment option for patients with benign prostatic hyperplasia (BPH) who had previously undergone pelvic radiation therapy.¹ These findings were presented at the 2026 American Urological Association Annual Meeting in Washington, DC.

Guo is an endourology fellow at Northwestern Medicine in Chicago, Illinois.

Guo explained that patients with prior pelvic radiation who subsequently develop bothersome lower urinary tract symptoms (LUTS) or urinary retention represent a particularly challenging population, as standard outlet procedures are associated with increased risks of complications, including urinary incontinence. Hemi-HoLEP was developed as a novel surgical approach that spares the smaller lateral lobe of the prostate, avoiding a circumferential epithelial defect and potentially reducing morbidity in patients who often have limited treatment options. The procedure is intended to provide symptom relief and restore spontaneous voiding in patients who may otherwise remain catheter dependent.

The study retrospectively identified 11 patients who underwent hemi-HoLEP after pelvic radiation and compared them with 33 propensity score–matched patients who underwent whole-gland HoLEP. Patients in the hemi-HoLEP cohort were more likely to be in urinary retention before surgery (64% vs 24%; P = .043). Enucleation time was significantly shorter with hemi-HoLEP (13.3 vs 16.9 minutes; P = .031), and all patients scheduled for same-day trial of void successfully passed. Additionally, there were no cases of urethral stricture or bladder neck contracture, and rates of postoperative complications and medical encounters within 90 days were comparable between cohorts (P > .05).

Although perioperative and short-term postoperative outcomes were favorable, urinary continence outcomes differed between groups. Guo noted that patients who received hemi-HoLEP were more likely to be using pads (P > .9) or diapers (P = .4) at 3 months post-operatively. Consistent with these findings, patients undergoing hemi-HoLEP demonstrated a modest increase in Michigan Incontinence Symptom Index (M-ISI) bother scores postoperatively, whereas patients in the control arm experienced slight decreases (0.27 vs-0.39; P = .04). Guo suggested that radiation-induced bladder inflammation and associated urgency and frequency symptoms may contribute to these findings.

Despite the increased incontinence burden, the investigators concluded that hemi-HoLEP appears to be a viable treatment option for selected post-radiation patients with BPH, while emphasizing the need for larger prospective studies to further define long-term outcomes.

REFERENCE

1. Guo JN, Patel AS, Xu P, Khondakar N, Meza J, Krambeck AE. IP03-19: SINGLE LATERAL LOBE SPARING HEMI-HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HEMI-HOLEP) OUTCOMES COMPARED TO STANDARD WHOLE-GLAND HOLEP. J Urol. 2026;215(5S):e85. doi:10.1097/01.JU.0001191280.81177.3f.19