title: HoLEP has come of age.
abstract: BACKGROUND
  Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment. Transurethral resection has been the reference 'gold standard', but due to its complications and issues with larger volume prostates, many alternatives have been developed and assessed. Holmium laser enucleation of the prostate (HoLEP) has shown excellent efficacy, durability and safety and has become an important alternative that has gained guideline approval.
  
  
  RESULTS
  HoLEP has been shown to have outcomes that are equivalent or better than TURP in both urodynamic measurements and symptom scores. Its outcomes have been proven to be durable and cost-effective. HoLEP has fewer and less serious complications when compared to the current reference standard, its use also allows earlier removal of catheter and hospital discharge. Appropriate mentoring reduces many of the issues associated with the steep learning curve, thus removing the main hurdle to its widespread adoption as the surgical treatment of choice for LUTS due to benign prostatic hyperplasia (BPH).
  
  
  CONCLUSIONS
  HoLEP fulfils all of the requirements as an alternative/replacement for TURP and open prostatectomy, with equivalent outcomes and reduced complications. With improvements in the learning curve, it could now be considered the true gold standard surgical treatment for BPH. HoLEP has come of age.
authors.affiliation: Department of Urology, Tauranga Hospital, Tauranga, New Zealand, drmwvincent@gmail.com.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Vincent
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gilling
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059032:Learning Curve; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000601:surgery*; D008297:Male; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome