BACKGROUND AND OBJECTIVE:Targeted plus perilesional biopsies are recommended for men with prostate lesions visible on magnetic resonance imaging. However, available data are mainly retrospective, without predefined biopsy scheme protocols. The MRI-Integrated Regional and targeted Approach, recommendations, and Guidelines for prostate biopsies (MIRAGE) study is the first prospective European study designed to evaluate the outcomes when perilesional biopsies are incorporated deliberately into the biopsy protocol. METHODS:MIRAGE was a prospective, observational, multicenter study conducted across ten European centers between January and June 2025. We enrolled 912 men with a single Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion. Targeted and perilesional biopsies were mandated, while distant biopsies (ie, cores taken beyond the perilesional zone) were left to the discretion of investigators. Detection rates of Gleason grade (GG) group ≥2 and 1 lesions were calculated separately for each scheme: targeted, perilesional, and distant biopsies. KEY FINDINGS AND LIMITATIONS:Targeted biopsy detected GG group ≥2 lesions in 380 men (41%). Compared with targeted biopsy alone, perilesional sampling increased GG group ≥2 lesion detection by +3.6% at the cost of +1% GG group 1 lesion detection. The greatest benefit of perilesional sampling was observed in biopsy-naïve men and those with PI-RADS 4-5 lesions. Conversely, in those with PI-RADS 3 or a prior negative biopsy, perilesional sampling yielded more cases of GG group 1 than of GG group ≥2. Distant sampling provided minimal incremental GG group ≥2 (contralateral: +1.6%; ipsilateral: +1.4%) but more GG group 1 (contralateral: +2.5%; ipsilateral: +2.9%) cases. CONCLUSIONS AND CLINICAL IMPLICATIONS:The MIRAGE study provides prospective evidence that, when a targeted plus perilesional biopsy strategy is applied, distant biopsies add minimal diagnostic benefit and should be omitted.

BACKGROUND AND OBJECTIVE:The transperineal (TP) route is recommended for prostate biopsy due to its superior safety profile. However, randomized evidence comparing the TP and the transrectal (TR) routes was generated through combined targeted and systematic biopsy frameworks, now challenged by lesion-focused strategies, defined as the combination of targeted (TB) and perilesional (PB) sampling without distant systematic cores. This study aimed to reassess the diagnostic performance of TP versus TR biopsy with the recommended TB + PB scheme. METHODS:This prospective multicenter, observational study was conducted across 10 European institutions between January 2025 and June 2025. We included 912 men with at least one magnetic resonance imaging (MRI)-visible lesion (Prostate Imaging-Reporting and Data System version 2.1 ≥3) who underwent either TP or TR MRI-targeted biopsy according to predefined TB + PB protocols. The primary outcome was the detection rate of clinically significant prostate cancer (csPC; Gleason Grade [GG] Group ≥2). KEY FINDINGS AND LIMITATIONS:TP biopsy detected more csPC than TR (48% vs 39%; OR [odds ratio]: 1.41, 95% CI [confidence interval]: 1.06-1.88; p = 0.017) without increasing the detection of insignificant PC (insPC) (18% vs 23%; p = 0.06). In multivariable mixed-effects analysis accounting for center-level clustering, the TP route remained independently associated with csPC detection (adjusted OR: 1.61, 95% CI: 1.17-2.23; p = 0.004). Limitations include limited power in selected subgroups and potential inter-center heterogeneity inherent to the observational design. CONCLUSIONS AND CLINICAL IMPLICATIONS:Within a standardized lesion-focused TB + PB framework, TP biopsy was independently associated with higher csPC detection without increasing insPC detection. This study focuses on diagnostic performance and does not provide direct comparative data on biopsy-related complications or patient-reported outcomes.

BACKGROUND AND OBJECTIVE:Irreversible electroporation (IRE) is an emerging non-thermal focal therapy for localized prostate cancer (PCa), offering tissue-selective ablation with functional preservation. This review aimed to delineate the 'ideal' candidate for primary IRE and provide practical guidance. METHODS:A narrative review (2014-2025) of primary IRE for localized PCa was conducted, including prospective series, multicentre registries, comparative studies, and systematic reviews. We synthesized baseline characteristics, lesion features, ablation strategy, oncologic/functional outcomes, and complications, focusing on cancer control and safety. RESULTS:The best outcomes were reported in men with magnetic resonance imaging-visible, organ-confined intermediate-risk (International Society for Urological Pathology [ISUP] 2-3) PCa, typically presenting a single dominant unilateral index lesion characterized by multiparametric MRI and biopsy. Contemporary series show in-field ablation of clinically significant cancer in ~80-90% with high functional preservation. The main limitation is out-of-field recurrence (~15-25% of failures), reflecting PCa multifocality. In-field persistence at 12 months was ~16% in the PRESERVE trial. Lesion size is a key practical constraint; current evidence and electrode geometry favour targets generally ≤20 mm. Limited comparative evidence, largely from a single study, suggests better oncologic control with hemi-gland IRE (clinically significant PCa persistence 8.6%) versus focal ablation (25%), whereas focal IRE better preserves erectile function. CONCLUSIONS AND CLINICAL IMPLICATIONS:Primary IRE appears safe and effective in selected localized PCa. The ideal candidate has unilateral MRI-visible, organ-confined ISUP 2-3 disease, prostate-specific antigen density <0.15-0.20 ng/mL/cm3, and a lesion small enough for reliable electrode coverage. Hemi-gland templates may improve oncologic reliability, whereas focal ablation maximizes functional outcomes. PATIENT SUMMARY:IRE is a focal, non-thermal treatment for localized PCa that can control the treated lesion while usually preserving urinary continence and often erectile function. Cancer can still occur elsewhere in the prostate after treatment, so follow-up is essential.

OBJECTIVE:To assess the oncological outcomes of targeted microwave ablation (TMA) using organ-based tracking (OBT) Fusion® via KOELIS Trinity® (KOELIS, Meylan, France) in men with intermediate-risk prostate cancer (PCa): the VIOLETTE trial (ClinicalTrials.gov identifier: NCT04582656) PATIENTS AND METHOD: In this prospective phase II, multicentre European study, men with a prostate-specific antigen (PSA) level <20 ng/mL, a single magnetic resonance imaging (MRI)-visible lesion ≤15 mm, International Society of Urological Pathology (ISUP) Grade Group 2 on MRI-targeted biopsy, and clinical T stage ≤2, were enrolled. The microwave applicator was placed using OBT Fusion guidance, either transperineally or transrectally. The primary endpoint was the absence of clinically significant PCa (csPCa), defined as ISUP Grade Group ≥2, within the treated area at 12 months. Secondary endpoints included safety, functional outcomes using validated measures, and the need for subsequent radical treatment. RESULTS:A total of 76 patients were treated across six centres with 66 (87%) completing the 12-month follow-up. At 6 months, six patients had csPCa after positive MRI control, including four within the treated area. At 12 months, csPCa was detected in 15 additional patients, including nine in-field recurrences, yielding an 81% in-field csPCa-free rate. Five serious adverse events in three patients were reported. Sexual (-2.5 points; P < 0.001) and ejaculatory (-1 points; P < 0.001) scores decreased significantly, whereas urinary function remained stable. Radical treatment was required in four (5.2%) patients at 12 months. CONCLUSION:Targeted microwave ablation using OBT Fusion technology appears to be a safe and effective focal therapy procedure for localised intermediate-risk PCa. The VIOLETTE trial achieved its primary endpoint, with 81% patients free of in-field csPCa at 12 months.

Objectives:This study aimed to perform a risk analysis of any prostate cancer (Pca) and of clinically significant prostate cancer (csPCa) in a contemporary cohort of prostatic biopsies. Materials and Methods:We conducted a retrospective analysis of patients who underwent prostate biopsies in our centre between December 2020 and December 2022. We calculated Pca and csPCa rate (ISUP grade ≥2). Univariate and multivariate regression models were constructed to assess independent predictive factors for Pca and csPCa. We used χ 2 automatic interaction detection (CHAID) for decision tree analysis. Results:We included 255 patients in the analysis, of whom 69.8% had positive biopsies for Pca and 36.9% for csPCa. Multivariate analysis found PSA density (PSAd) (OR = 1.001) (1.000; 1.001), PIRADS score (OR = 1.393) (1.234; 1.571) as independent predictive factors of csPCa. For the detection of any PCa, CHAID analysis revealed that patients with PIRADS score ≤4 doubled the risk of negative biopsies (from 22.6% to 54.3%) when the prostate volume was >46 mL. Conclusion:For patients with a PIRADS ≤4, a large prostate volume (>46 mL) was a predictor of negative biopsies, independently of PSAd. MRI interpretation and targeting in these patients should therefore be performed with particular caution.

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging men. As the incidence of prostate cancer (PCa) increases with age, coexistence of BPO and PCa is a frequent issue. Radical prostatectomy might be considered as the best option for patients presenting with severe obstructive symptoms, allowing to simultaneously treat both diseases. However, not all patients are eligible or prefer surgery, therefore a large number of patients are referred to receive PCa radiotherapy (RT). Preexisting LUTS represent a well-known risk factor to develop severe genito-urinary (GU) toxicity. While improving urinary function before starting irradiation appears to be crucial, the development of new minimally invasive surgical therapies (MIST) for BPH creates new opportunities for treatment personalization in RT patients with LUTS.

Surgery for benign prostatic hyperplasia (BPH) accounts for more than 67,000 procedures annually in France, of whom 70

BACKGROUND:Patient-derived organoids (PDOs) and organotypic slice tissues have emerged as promising platforms to model prostate cancer (PCa) in three dimensions (3D), preserving tumor architecture and molecular features. Their relevance as translational tools for precision oncology, however, remains incompletely defined. OBJECTIVE:To systematically assess the feasibility, molecular fidelity, and translational applications of 3D models in PCa. METHODS:We conducted a comprehensive systematic literature review (PROSPERO CRD42025643117) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published until December 2024 were screened across PubMed, EMBASE, and Web of Science. Original studies involving human-derived PCa 3D models were included. Data were extracted on organoid generation efficiency, molecular profiling, biomarker exploration, and drug testing outcomes. KEY FINDINGS AND LIMITATIONS:Success rates for PDO establishment varied widely (15-90%), influenced by sample type, disease stage, and matrix conditions. Long-term expansion beyond 5-10 passages was achieved in a minority of models, particularly from radical prostatectomy. Despite these limitations, PDOs showed high genomic, transcriptomic, and epigenetic concordance with patient tumors, including key alterations in androgen receptor (AR) signaling, Tumor Protein (TP) 53, Phosphatase and TENsin homolog (PTEN), Phosphoinositide-3-Kinase/Protein Kinase B (PI3K/AKT), and neuroendocrine markers. Organoids retained intratumoral heterogeneity and were suitable for single-cell sequencing. Biomarker studies identified Enhancer of Zest Homolog 2 (EZH2), SeCretoGranin 2 (SCG2), Human Epidermal Growth factor receptor 3 (HER3), and methylation patterns as relevant for subtype classification. Drug screening recapitulated known therapeutic responses and highlighted actionable resistance mechanisms, including differential sensitivity to androgen receptor pathway inhibitors, taxanes, poly(adenosine diphosphate-ribose)-polymerase inhibitors, and PI3K/AKT-targeted therapies. However, the lack of microenvironment components and the time-intensive nature of organoid establishment remain key limitations. CONCLUSIONS AND CLINICAL IMPLICATIONS:Prostate cancer 3D models offer a relevant, patient-specific platform to study tumor biology, predict drug responses, and identify novel biomarkers. While standardization and scalability challenges persist, organoids have a strong potential for integration into precision oncology pipelines.

This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. In total, 144 patients were included, with 71 (49.3

OBJECTIVE:To evaluate the accuracy of bladder scanners in measuring bladder volume and to compare their precision. METHOD:MEDLINE and Cochrane databases were searched from January 1, 1990 to December 30th, 2023. We selected studies assessing results of bladder volume measurement using bladder scanners, standard ultrasonography or bladder catheterization. RESULTS:In total, 177 studies were screened, of which 22 were included in the final analysis. According to the literature, there is no clinically significant difference in the measurement of bladder volume using urethro-vesical catheterization, bladder scanner, or conventional ultrasound. Studies comparing different types of bladder scanners did not show any difference in accuracy. CONCLUSIONS:Bladder scanners are precise tools to evaluate bladder volume in urological patients, applicable in daily practice. Knowledge of the patient's medical history is crucial to better interpret the measurement.

OBJECTIVE:The male lower urinary tract symptoms (LUTS) panel of the French Urological Association (AFU) aimed to update the 2012 French guidelines for pharmacological treatment of LUTS secondary to benign prostatic hyperplasia (BPH). METHODS:A systematic review of articles published between 2012 and 2024 was conducted in PubMed® to update the previous guidelines. The methodology included a predefined search strategy, critical appraisal of the literature with assignment of evidence levels, and the development of evidence-based conclusions and recommendations. RESULTS/RECOMMENDATIONS:Monitoring may be offered to patients with mild to moderate LUTS who are not bothered by their symptoms. Men with LUTS should be offered lifestyle and dietary advice before or when initiating treatment. Alpha-blockers may be offered to patients with moderate to severe LUTS as first-line therapy. 5-alpha-reductase inhibitors (5-ARIs) may be offered to patients with moderate to severe LUTS and prostate volume above 40mL, though their therapeutic benefit requires sustained long-term administration. Combination therapy with alpha-blockers and 5-ARIs is indicated for moderate to severe LUTS when prostate volume exceeds 40mL. Serenoa repens in its hexanic extract formulation may be considered for mild to moderate LUTS. Antimuscarinics or beta-3 agonists may be offered to patients with moderate to severe LUTS and predominant storage symptoms as second-line therapy. Tadalafil alone or combined with alpha-blockers is recommended for moderate to severe LUTS, particularly when erectile dysfunction coexists. CONCLUSION:These recommendations provide urologists with evidence-based guidance for more personalized management of BPH-related LUTS.

OBJECTIVE:The Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Association of Urology (AFU) undertook an update of the French recommendations published in 2021, as well as those of the European Association of Urology (EAU) released in 2024, regarding the surgical and interventional management of bladder outlet obstruction (BOO) related to benign prostatic hyperplasia (BPH). METHODS:A systematic review of the literature was conducted through PubMed® for the period 2023-2025, complementing the data already included in previous guidelines. This process was based on a predefined bibliographic strategy, followed by a critical analyze of the publications with assignment of levels of evidence, formulation of conclusions, and development of recommendations addressing specific clinical questions. RESULTS AND RECOMMENDATIONS:Offer Bladder Neck Incision (BNI) for patients with moderate-to-severe LUTS and prostate volume <30cm3 without a median lobe. Offer bipolar or monopolar transurethral resection of the prostate (TURP) for patients with moderate-to-severe LUTS and a prostate volume between 30 and 80cm3. GreenLight™ or bipolar laser vaporization are alternatives to TURP, with GreenLight™ laser vaporization particularly suitable for patients at risk of bleeding. Offer endoscopic enucleation of the prostate as an alternative to TURP and open simple prostatectomy (OSP) for patients with moderate-to-severe LUTS. OSP may be offered for patients with moderate-to-severe LUTS and prostate volume >80cm3 in centers without access to endoscopic enucleation. Minimally invasive simple prostatectomy is an alternative to OSP in centers lacking access to endoscopic enucleation techniques. Prostatic artery embolization (PAE) can be considered for patients with moderate-to-severe LUTS who desire a minimally invasive option and accept inferior outcomes compared with TURP, the indication should be confirmed by both a urologist and an interventional radiologist experienced in the procedure. Minimal volume for PAE is 40cm3 but has better efficacy for prostatic volume >80cm3. Prostatic artery embolization (PAE) may be offered to patients with moderate-to-severe LUTS who desire a minimally invasive option and accept inferior outcomes compared with TURP, the indication should be confirmed by both a urologist and an interventional radiologist experienced in the procedure. Minimal volume for PAE is 40cm3 but has better efficacy for prostatic volume >80cm3. Aquablation may be offered as an alternative to TURP for patients with moderate-to-severe LUTS and a prostate volume between 30 and 80cm3. UroLift™ implants are an alternative for patients with moderate-to-severe LUTS desiring preservation of ejaculatory function and with prostate volumes <80mL without a median lobe. Rezūm™ may be offered as a surgical option for men with moderate-to-severe LUTS, desiring ejaculatory preservation, and with prostate volumes of 30-80mL. Tind™ cannot currently be recommended for routine practice due to insufficient long-term data and lack of comparison with reference surgical techniques. CONCLUSION:Advances in surgical and interventional approaches to the management of BOO related to BPH are moving toward reducing treatment-related morbidity, while increasingly incorporating patients' quality of life into therapeutic objectives, beyond the sole relief of LUTS.

Advances in imaging modalities and radiotherapy (RT) technologies have enabled the development of focal RT approaches for localized prostate cancer (PCa). This systematic review aims to evaluate the oncological and toxicity outcomes of focal or partial-gland RT, while also discussing the optimal patient selection criteria and treatment planning strategies for this emerging approach. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed on February, 2025, on Pubmed, with the keywords “focal RT” and “definitive” and “prostate cancer”; and “focal brachytherapy (BT)” and “definitive” and “prostate cancer”. Both focal BT and partial-gland stereotactic body radiotherapy (SBRT) strategies demonstrated a minimal impact on toxicity and quality of life parameters. Only a transient increase in urinary frequency was suggested at 6–12 months following focal treatment, returning to baseline thereafter. In highly selected low-risk (LR) and intermediate-risk (IR) PCa patients with both excellent radiological-histological concordance and a limited number of positive cores, focal RT demonstrated excellent biochemical relapse-free survival and metastasis-free survival, reaching up to 97

Objectives:To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours. Patients and methods:We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine. Results:A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed. Conclusions:These initial results suggest that hydrodissection of the prostate-rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.

This narrative review aims to examine the biological mechanisms of toxicity in patients with benign prostatic hyperplasia (BPH) receiving prostate cancer (PCa) external beam radiotherapy (RT), as well as possible strategies to prevent genitourinary (GU) toxicity following PCa RT in men with BPH, through the adaptation of both medical, surgical, and irradiation strategies. A broad literature search was performed in November 2024 in the PubMed database with the terms “prostate cancer”, “prostate epithelial cells”, “prostate stromal cells”, “radiation therapy”, “lower urinary tract symptoms”, “stereotactic body radiotherapy”, “transurethral resection of the prostate”, “enucleation”. RT affects several pathophysiological contributors to LUTS, such as urothelial dysfunction, prostatic inflammation and bladder fibrosis. While preexisting LUTS appear to be a risk factor to develop severe GU toxicity following PCa RT, the development of strategies reducing the incidental dose delivered to urinary structures appears to be particularly relevant. Urethra-sparing strategies holds the potential to reduce the onset of severe GU toxicity following PCa RT. The relationship between the highest doses delivered to the bladder and the onset of severe GU toxicity highlight the pivotal role of image-guided radiotherapy (IGRT) for PCa RT. Aggressive margin reduction from 4 mm to 2 mm demonstrated its ability to halve the risk to develop severe GU toxicity 2 years following SBRT. De-escalation in either dose or target volume represent appealing strategies, currently assessed within prospective trials. Both assessment and optimization of urinary function through medical or surgical approaches is mandatory before RT. Strategies designed to reduce the planned and delivered dose to functional structures hold promise for the limitation of urinary toxicity after PCa RT. Further efforts should be made to adapt surgical and irradiation techniques in men with BPH, with the development of studies dedicated to this population of patients.

Background and objective Histopathological examination of surgical specimens for benign prostatic hyperplasia (BPH) can detect incidental prostate cancer (iPCa). The aim of our study was to develop a predictive model for iPCa diagnosis for patients for whom BPH surgery is being considered. Methods We conducted a retrospective analysis of medical files for patients who underwent BPH surgery in three academic centers between 2012 and 2022. Patients diagnosed with PCa before surgery were excluded. We calculated the global iPCa rate, and the clinically significant iPCa rate (grade group ≥2). Univariate and multivariable regression models were used to assess factors predictive of iPCa. The area under the receiver operating characteristic curve (AUC) was compared for each risk factor and for the global model. We used χ2 automated interaction detection (CHAID) for decision tree analysis. Key findings and limitations We included 2452 patients in the analysis, of whom 247 (10.0%) had iPCa, which was clinically significant in 49/247 cases (20.2%). Multivariable analysis revealed that age and prostate-specific antigen density (PSAD) were independent predictive factors for iPCa diagnosis. The AUC for a model including age and PSAD was 0.65. CHAID analysis revealed that patients with PSAD >0.1 ng/ml/cm3 had an iPCa risk of 23.4% (χ2 = 52.6; p < 0.001). For those patients, age >72 yr increased the iPCa risk to 35.4% (χ2 = 11.1, p = 0.008). Our study is mainly limited by its retrospective design. Conclusions and clinical implications Age and PSAD were independent risk factors for iPCa diagnosis. The combination of age >72 yr and PSAD >0.1 ng/ml/cm3 was associated with an iPCa rate of 35.4%. Patient summary We performed a study to find predictors of prostate cancer for patients undergoing surgery for benign enlargement of the prostate. Our model can identify patients at risk, and diagnose their cancer before surgery. This could avoid unnecessary or harmful procedures.

INTRODUCTION:Benign prostatic hyperplasia (BPH) is a prevalent condition in ageing men, often resulting in significant lower urinary tract symptoms (LUTS) that impact quality of life. For patients with huge prostate volumes (>150mL), surgical management presents challenges. Traditionally, open simple prostatectomy (OSP) was the gold standard; however, minimally invasive approaches such as robotic-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP), especially holmium laser enucleation of the prostate (HoLEP), offer similar or superior outcomes with reduced morbidity. METHODS:This review analyzed studies comparing the perioperative, functional, and complication outcomes of RASP and HoLEP in treating very large prostates (>150mL). A comprehensive literature search was performed to evaluate evidence on surgical efficacy, complication rates, and recovery profiles. RESULTS:Both RASP and HoLEP demonstrated excellent perioperative outcomes, with HoLEP providing reduced operative time and hospital stays. HoLEP also showed lower blood loss and a reduced need for transfusions, while RASP offered advantages in terms of precision and surgeon control, especially for anatomically complex cases. Functional outcomes, including improvement in urinary flow and symptom scores, were comparable between the two techniques. However, complications such as transient incontinence were more commonly reported with HoLEP. CONCLUSION:Both RASP and HoLEP are effective and safe for the management of very large prostates. HoLEP offers significant advantages in perioperative recovery and reduced morbidity, whereas RASP provides excellent outcomes in complex cases requiring precise dissection. The choice between these techniques should be guided by patient-specific factors and surgical expertise. Future studies should focus on long-term functional outcomes to refine surgical recommendations further.