1. Introduction

Benign prostatic hyperplasia (BPH) is one of the most common urological diseases in elderly men, representing a benign enlargement of the prostate tissue, which with age leads to obstruction of the lower urinary tract and the development of lower urinary tract symptoms (LUTS), thereby placing a significant burden on the healthcare system [2;3]. The development of laser technologies has opened new possibilities for minimally invasive treatment; however, issues regarding the differential selection of intervention methods remain unresolved. In addition, the relatively high frequency of postoperative complications underscores the urgent need to optimize surgical tactics [1].

2. Materials and Methods

The study was based on the analysis of 261 patients with benign prostatic hyperplasia (BPH) who underwent surgical treatment from 2021 to 2024 at the private clinic “Soglom Avlod” in Andijan and the private clinic “Bio Test Medical” in Fergana. The patients were conditionally divided into the following periods:

• Comparison group (HoLEP) – 122 patients (46.7%), 2021–2022, who were treated according to conventional approaches;

• Main group (MiLEP) – 139 patients (53.3%), 2023–2024, where an optimized surgical tactic was applied.

Patient age was distributed according to the WHO classification, 2021. Clinical analysis showed that most patients in both groups belonged to the 60–74 years age category, corresponding to the typical demographic profile of BPH. The distribution between the groups was comparable, and no statistically significant differences in age were observed (p>0.05).

Prostate volume of 40–60 cm³ in the comparison group included 46 patients (37.7%), while in the main group – 51 patients (36.7%). Prostate volume of 61–80 cm³ accounted for 52 patients (42.6%) in the comparison group and 59 patients (42.4%) in the main group. Prostate volume greater than 80 cm³ was observed in 24 patients (19.7%) in the comparison group and 29 patients (20.9%) in the main group. The majority of patients had a prostate volume of 61–80 cm³. This allows for a valid comparison of the effectiveness of HoLEP and MiLEP.

All patients underwent minimally invasive laser enucleation of the prostatic tissue: in the comparison group with HoLEP – 122 patients (100%), and in the main group with MiLEP – 139 patients (100%). In the comparison group, HoLEP was performed using a laser instrument with a diameter of 22–24 F, whereas in the main group, a 19 F instrument was used. Additionally, in the main group, postoperative daily laser therapy was performed for 5 consecutive days using the domestically produced licensed device “Vostok-1”.

The mean prostate-specific antigen (PSA) level was 5.6 ± 2.1 ng/mL in the comparison group and 5.8 ± 2.3 ng/mL in the main group. Post-void residual urine volume was 68 ± 24 mL and 65 ± 22 mL, respectively. Maximum urinary flow rate (Qmax) was 9.2 ± 3.5 mL/s in the comparison group and 9.6 ± 3.2 mL/s in the main group.

It should be noted that patient examination, diagnostics, preoperative preparation, selection of surgical methods, and postoperative management of patients with BPH were carried out in accordance with the generally recognized latest clinical guidelines, which are adopted and approved by the Ministry of Health of the Republic of Uzbekistan.

3. Results and Discussion

In the comparison group (HoLEP, n=122), the majority of patients (62.3%) were aged 60–74 years, corresponding to the peak clinical manifestation of BPH. Patients over 75 years accounted for 23%, demonstrating a significant prevalence of comorbidities. A smaller proportion of patients aged 55–59 years was observed due to the lower prevalence of BPH symptoms in this age category.

The most common prostate volume was 60–79 mL (42.6%), which necessitated careful enucleation of the nodules and meticulous hemostasis. A volume ≥80 mL was observed in one-fifth (19.7%) of cases, increasing the risk of urethral injury and stricture formation.

The presence of comorbidities in 60.7% of patients required an individualized approach to anesthesia and postoperative management. Hypertension and type 2 diabetes mellitus posed additional risks for bleeding and infectious complications. The use of a 22–24 F instrument increased the risk of urethral trauma, which later contributed to a higher incidence of strictures. Furthermore, a surgical duration exceeding 90 minutes in some patients (26.2%) also contributed to an increased likelihood of postoperative complications.

Evaluation of Postoperative Outcomes

When evaluating the results of surgical treatment in patients with BPH, the course of the early postoperative period is of significant importance.

In the comparison group (HoLEP, n=122), the overall complication rate was 36.1%, indicating substantial tissue trauma and insufficient individualization of the intervention.

The most common complications were:

• Urethral injuries – 15 patients (12.3%), associated with the use of the standard 22–24 F instrument and prolonged surgeries;

• Residual urine >50 mL – 12 patients (9.8%), reflecting partial preservation of hyperplastic tissue and insufficient postoperative stimulation for lower urinary tract function recovery;

• Bleeding – 7 patients (5.7%) and infections – 5 patients (4.1%), more frequently observed in patients with comorbidities (type 2 diabetes, hypertension, chronic heart failure);

• Urinary retention – 5 patients (4.1%), primarily in elderly patients over 75 years of age.

Postoperative Outcomes and Long-Term Assessment

The use of large instruments (22–24 F) and prolonged surgical duration contributed to an increased frequency of urethral injuries and residual urine. Infectious complications were observed predominantly in patients with comorbidities, such as type 2 diabetes mellitus and chronic pyelonephritis.

The quality of surgical treatment in patients with BPH is assessed based on long-term outcomes. The incidence of urethral strictures (6.6%) indicates the need for preventive measures, while the ineffectiveness of bougienage in 5 patients (4.1%) required repeat interventions, highlighting the necessity to revise surgical tactics. A high rate of retrograde ejaculation (24.6%) negatively affects patient satisfaction.

Identified Gaps and Limitations

1. Lack of preventive measures for urethral strictures;

2. Use of a standard instrument diameter for all patients (22–24 F);

3. Limited individualization of the intervention;

4. Ineffectiveness of bougienage in some patients (urethral strictures);

5. High frequency of complications affecting quality of life (retrograde ejaculation, residual urine);

6. Absence of postoperative laser stimulation to accelerate reparative processes.

4. Conclusions

Thus, the analysis of surgical outcomes in the comparison group showed that the standard HoLEP technique is associated with a significant frequency of both early and long-term complications. The most clinically significant problems were urethral injuries, stricture formation, and urinary dysfunction, which in some cases required repeat endoscopic interventions. The high incidence of retrograde ejaculation and residual urine reduced patient satisfaction with treatment outcomes. These findings justified the need to optimize surgical tactics, implement individualized intervention principles, and introduce preventive measures, which formed the basis for the development and implementation of the modified MiLEP technique.