Risk of New-Onset Postoperative Depression After Holmium Laser Enucleation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Nationwide Retrospective Cohort Study

Background/Objectives: Depression is a frequently overlooked but clinically important complication following surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to compare the risk of new-onset postoperative depression following transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in patients with BPH. Methods: We conducted a retrospective cohort study using the Korean Health Insurance Review and Assessment database. Patients diagnosed with BPH between 2013 and 2022 who underwent TURP or HoLEP and had no prior diagnosis of a psychiatric disorder were included (n = 30,878 and n = 21,521, respectively). The primary outcome was a diagnosis of depression within one year after surgery. Multivariable logistic regression and propensity score matching were used to adjust for covariates, including age, comorbidities, medication use, geographic region, and hospital level. Sensitivity analyses were conducted using follow-up periods of one, three, six, and nine months. Results: In the unadjusted model, HoLEP was associated with higher odds of postoperative depression compared with TURP (odds ratio [OR] = 1.338, 95% confidence interval [CI]: 1.245–1.438; p < 0.0001). This association remained significant after multivariable adjustment (OR = 1.350, 95% CI: 1.255–1.451; p < 0.0001) and propensity score matching (OR = 1.364, 95% CI: 1.259–1.476; p < 0.0001). The association was observed across alternative follow-up windows in the sensitivity analyses. Conclusions: HoLEP is associated with higher odds of new-onset postoperative depression compared with TURP. These findings may inform perioperative mental health assessment for patients undergoing surgical treatment for BPH, and warrant further evaluation to establish causality or clarify the underlying mechanism.