Introduction: We aimed to compare the effectiveness and safety of transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization of the prostate (PVP) in management of storage and overactive bladder (OAB) symptoms complicating benign prostatic hyperplasia (BPH) in patients with moderately enlarged prostates.

Methods: The charts of patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms who were treated by TURP, HoLEP, and PVP at University of Cincinnati hospitals between March 2012 and December 2020 were retrospectively reviewed and analyzed for changes in storage and OAB symptomatology, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and postvoid residual (PVR) from baseline to up to six months postoperatively. 

Results: A total of 204 patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms were divided into three groups: group 1 (patients who underwent TURP, 89 patients), group 2 (those who underwent HoLEP, 64 patients), and group 3 (those who underwent PVP, 51 patients). TURP, HoLEP, and PVP were associated with significant improvement in urodynamics study (UDS) parameters, patient storage and OAB symptomatology, and IPSS from preoperatively to both three and six months postoperatively in BPH patients with moderately enlarged prostates, with relatively low procedure complication rate and postoperative need for either anticholinergic or procedure.

Conclusions: TURP, HoLEP, and PVP are effective and reliable surgical procedures that can be relied upon for BPH patients with moderately enlarged prostates and storage or OAB symptoms, with comparable efficacy and relatively low procedure complication rate and postoperative need for anticholinergic or additional procedure.