Lasers in Medical Science

, Volume 33, Issue 3, pp 589–595 | Cite as

Benign prostatic hyperplasia surgical scoring (BPHSS): an novel scoring system for the perioperative outcomes of holmium laser enucleation of the prostate

  • Huan Xu
  • Zhikang Cai
  • Yanbo Chen
  • Meng Gu
  • Qi Chen
  • Zhong Wang
Original Article


To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6–8 points) showed significant increase in the OT (74.61, 95%CI = 16.98–327.84, P < 0.001), hemochrome reduction (416.50, 95%CI = 35.48–4889.88, P < 0.001), hospital stay (1.80, 95%CI = 1.35–2.41, P < 0.001), and bladder irrigation duration (4.04, 95%CI = 1.35–12.10, P = 0.013) compared with the low BPHSS group (0–2 points). In the prospective study, there also existed significant differences between the three scoring grades (P < 0.01) in OT, hemochrome decrease, and the hospital stay. The BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. Further studies are needed to validate this scoring system in BPH patients in multiple centers.


Benign prostatic hyperplasia Holmium laser enucleation of the prostate Perioperative outcomes Scoring system 



benign prostatic hyperplasia


BPH surgical scoring


holmium laser enucleation of the prostate


operation time


prostatic volume


prostate-specific antigen


intravesical prostatic protrusion


metabolic syndrome


transurethral enucleation of the prostate


transurethral resection of the prostate


postvoid residual


receiver operating characteristic


European Association of Urology


area under the curve


overactive bladder


prostatic arterial embolization


5-α reductase inhibitors


lower urinary tract symptoms


Funding information

This research was supported by Shanghai Pudong new area health and family planning project (NO. PW2013D-3), key disciplines group construction project of Pudong Health Bureau of Shanghai (PWZxq2014-11), Program for Outstanding Medical Academic Leader, and Speciality Construction Project of Pudong Health, and Family Commission of Shanghai (NO. PWZz2013-16).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Ethics approval and consent to participate: ethical approval of the patients were obtained in our study from Shanghai 9th People’s Hospital Ethics Committee.

Informed consent

Written informed consent was obtained from each patient.

Supplementary material

10103_2017_2425_Fig2_ESM.gif (181 kb)
Supplemental Figure 1

The flow diagram of this trial. (GIF 180 kb)

10103_2017_2425_MOESM1_ESM.tif (2.6 mb)
High resolution image (TIFF 2709 kb)
10103_2017_2425_MOESM2_ESM.docx (17 kb)
Supplemental Table 1 (DOCX 16 kb)


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, Shanghai Ninth People’s HospitalShanghai Jiao tong University School of MedicineShanghaiChina

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