To evaluate the surgical and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic bladder outlet obstruction in benign prostatic hyperplasia (BPH) patient with the ​application of the Modified Clavien Classification System.

We prospectively studied 45 patients, who underwent HoLEP for benign prostatic hyperplasia performed by a single surgeon between July 2014 and May 2017.All enrolled patients demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. We investigated complications that occurred during and within 3 month after surgery and classified them into grade I to grade V on the basis of the Modified Clavien system.  Preoperative vs postoperative findings were compared with Student-t or Fisher-Exact tests.

The mean follow-up time was 9 months (3 to 22) months and the mean patient age
70±8years. The mean prostate volume was 74.6±34.3mL. The mean operation time was 100±22.2 min including a mean morcellation time of 20±10 min. The mean weight of enucleated tissue, mean duration of catheterization, means hospital stay also noted. Two patients (4%) had prostate tissue in the bladder. Urinary incontinence occurred in one patient (2%). The rate of post-HoLEP complications by use of the MCCS was 20%. The most frequent complications were grade I with grade II complications the next most frequent (24.3%). We noted no Clavien 4 or 5 complications during follow-up

Improvements in IPSSs, Qmax values, and PVR volumes prove that the surgical outcomes are good.QoL scores improved more than 2 times when compared to pre-operative period, one month after surgery.Sexual functioning was improved after HoLEP in our study but not significant values.
The HoLEP procedure helped to preserve sexual functions, but retrograde ejaculation still remains
a problem.Improvements in voiding and sexual activity caused QoL scores to rise.The fall in PSA level may be associated with prostate debulking. The reduction of large post-void residual is due to relieve the obstruction. HoLEP is a safe procedure with acceptable complications and presents an acceptable continence rate.No complication was life-threatening

In HoLEP significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted along with a low complication rate (MCCS), during follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.