Benign prostatic hyperplasia (BPH) is a common condition in aging men that often requires surgical intervention when symptoms become severe. Holmium Laser Enucleation of the Prostate (HoLEP) is a well-established treatment with proven safety and efficacy. However, postoperative complications such as temporary stress incontinence and urethral stricture remain concerns. The 22 French (F) sheath is a novel tool designed to reduce urethral trauma compared to the traditional 26F sheath. 

To compare the incidence of urethral stricture, functional outcomes, and complications in patients undergoing HoLEP using either the 22F or 26F sheath.

This retrospective analysis included prospectively collected data from patients who underwent HoLEP between July 2023 and September 2024. Patients were randomized into two groups: Group 1 (22F sheath) and Group 2 (26F sheath). Outcomes assessed included the incidence of urethral stricture, Qmax, International Prostate Symptom Score (IPSS), and post-void residual (PVR) at 1, 3, and 6 months postoperatively. Statistical analysis was performed using the Julius.ai platform. Independent-sample t-tests and chi-square tests were used, with a p-value of < 0.05 considered statistically significant.

A total of 122 patients were included (62 in Group 1 and 60 in Group 2). baseline parameters (table1). There was no statistically significant difference in urethral stricture rates between the groups (3.2% vs. 6.7%; p = 0.64). Transient stress incontinence was lower in the 22F group at all time points, with a significant difference at 3 months (p = 0.049). Both groups showed improvement over time, with incontinence rates approaching zero at 6 months. Group 1 demonstrated significantly greater improvement in mean IPSS scores at all follow-up intervals (p = 0.026). Improvements in Qmax and PVR favored the 22F group but did not reach statistical significance (table 2). Two patients from each group were readmitted for clot retention; no blood transfusions were required. No major complications were reported aside from urethral strictures.

These findings suggest that using a smaller 22F sheath during HoLEP may enhance patient outcomes, particularly by improving early symptom relief and reducing transient incontinence. Although the reduction in urethral stricture was not statistically significant, the overall trend supports the potential of the 22F sheath to minimize procedural trauma without compromising surgical efficacy

The use of a smaller 22F sheath in HoLEP showed promising results in improving early IPSS scores without a statistically significant difference in postoperative urethral stricture. Larger studies are needed to validate these findings