Comparative Neurocognitive Outcomes Following Prostate Surgery

March 12, 2026 updated by: Cengiz Canakci, MD

Comparative Neurocognitive Outcomes Following Holmium Laser Enucleation and Transurethral Resection of the Prostate: A Prospective Cohort Study

This prospective observational cohort study aims to evaluate postoperative cognitive outcomes in patients undergoing surgical treatment for benign prostatic hyperplasia (BPH). Two commonly used surgical techniques-Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP)-will be compared. Cognitive function will be assessed before surgery and three months after surgery using validated neurocognitive and psychological assessment tools. The primary outcome measure is the change in Montreal Cognitive Assessment (MoCA) score. Secondary outcomes include changes in Mini-Mental State Examination (MMSE), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) scores. The study aims to determine whether the type of surgical technique independently influences postoperative cognitive function after adjusting for important patient-related factors such as age and educational level.

Study Overview

Status

Completed

Conditions

Detailed Description

Benign prostatic hyperplasia (BPH) is a common condition among aging men and is one of the most frequent causes of lower urinary tract symptoms. When symptoms become moderate to severe and do not respond adequately to medical therapy, surgical treatment is recommended. Transurethral resection of the prostate (TURP) has long been considered the standard surgical approach for BPH, while Holmium Laser Enucleation of the Prostate (HoLEP) has emerged as an effective minimally invasive alternative with favorable perioperative outcomes.

Although these procedures are widely used and generally considered safe, concerns remain regarding potential postoperative cognitive changes, particularly in elderly surgical populations. Postoperative cognitive dysfunction has been described after various surgical procedures and may affect patient recovery, functional independence, and quality of life. However, limited data are available regarding cognitive outcomes after BPH surgery, and direct comparisons between different surgical techniques remain scarce.

Most previous studies assessing cognitive outcomes after urological surgery have relied on the Mini-Mental State Examination (MMSE), which may have limited sensitivity in detecting mild cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a more sensitive tool that evaluates multiple cognitive domains including executive function, attention, memory, language, and visuospatial ability.

This prospective observational cohort study aims to compare postoperative cognitive trajectories in patients undergoing HoLEP or TURP for symptomatic BPH. Eligible patients will undergo standardized cognitive and psychological assessments before surgery and three months postoperatively. The primary outcome is the change in MoCA score over time. Secondary outcomes include changes in MMSE, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) scores.

Statistical analyses will evaluate longitudinal changes in cognitive outcomes and investigate whether surgical technique independently influences postoperative cognitive performance after adjustment for potential confounding factors such as age and educational level.

The findings of this study may contribute to a better understanding of the neurocognitive safety of modern endoscopic prostate surgery and help clinicians and patients make more informed decisions when selecting the most appropriate surgical treatment for BPH.

Study Type

Observational

Enrollment (Actual)

132

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye)
        • Health Science University Kartal Dr. Lütfi Kırdar City Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patients undergoing surgical treatment for symptomatic BPH at a tertiary urology center.

Description

Inclusion Criteria:

  • Male patients aged 55-80 years
  • Symptomatic benign prostatic hyperplasia requiring surgery
  • Prostate volume 50-100 cc
  • Baseline MMSE ≥ 24
  • Ability to complete cognitive tests independently

Exclusion Criteria:

  • Neurodegenerative diseases (Alzheimer's, Parkinson's)
  • History of cerebrovascular accident with deficits
  • Traumatic brain injury
  • Severe psychiatric disorders
  • Alcohol or substance abuse Chronic sedative or antipsychotic use
  • Severe visual or auditory impairment
  • Previous prostate surgery
  • Active malignancy
  • Perioperative complications requiring ICU admission

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
HoLEP

Participants were divided into two cohorts based on the surgical procedure performed for the treatment of benign prostatic hyperplasia (BPH). One cohort included patients undergoing Holmium Laser Enucleation of the Prostate (HoLEP), and the other cohort included patients undergoing Transurethral Resection of the Prostate (TURP). The choice of surgical technique was determined according to clinical indications and institutional practice rather than study participation.

All participants underwent standardized preoperative and postoperative evaluations. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Psychological status was evaluated using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Assessments were performed before surgery and repeated three months after surgery to evaluate potential changes in cognitive and psychological outcomes
TURP

Participants were divided into two cohorts based on the surgical procedure performed for the treatment of benign prostatic hyperplasia (BPH). One cohort included patients undergoing Holmium Laser Enucleation of the Prostate (HoLEP), and the other cohort included patients undergoing Transurethral Resection of the Prostate (TURP). The choice of surgical technique was determined according to clinical indications and institutional practice rather than study participation.

All participants underwent standardized preoperative and postoperative evaluations. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Psychological status was evaluated using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Assessments were performed before surgery and repeated three months after surgery to evaluate potential changes in cognitive and psychological outcomes

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
changes from cognitive function
Time Frame: 3 months
The primary objective of this study was to utilize the Montreal Cognitive Assessment three months post-surgery to examine and evaluate cognitive alterations following HoLEP and TURP procedures
3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cengiz Canakci, MD

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 8, 2025

Primary Completion (Actual)

December 2, 2025

Study Completion (Actual)

March 1, 2026

Study Registration Dates

First Submitted

March 9, 2026

First Submitted That Met QC Criteria

March 9, 2026

First Posted (Actual)

March 12, 2026

Study Record Updates

Last Update Posted (Actual)

March 16, 2026

Last Update Submitted That Met QC Criteria

March 12, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Canakci002

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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