BACKGROUND: The purpose of this study is to evaluate the efficacy and safety of holmium laser prostatectomy in patients diagnosed with primary bladder neck obstruction (PBNO), compared with patients with benign prostatic hyperplasia (BPH). METHODS: We analyzed the databases of patients who underwent a holmium laser prostatectomy or enucleation of the prostate for PBNO and BPH between January 2018 and August 2022. PBNO was diagnosed primarily based on cystourethroscopic findings. Patients were followed up according to a regular protocol at 2 weeks, 3 mo, and 6 mo postoperatively. RESULTS: In total, 28 and 447 patients with PBNO and BPH, respectively, were identified. Preoperative urodynamic studies showed that detrusor underactivity was significantly more prevalent in the PBNO group (78.6%) than in the BPH group (57.5%) (p <
0.01). Both PBNO and BPH groups showed significant improvements in the total International Prostate Symptom Score, Overactive Bladder Symptom Score, and maximum flow rate at 6 mo postoperatively compared with the preoperative values (p <
0.01). Subjective satisfaction 6 mo after operation was not significantly different between the PBNO and BPH groups (p >
0.05). Complications in the PBNO group included recatheterization (n = 1, 3.5%), with no patients requiring blood transfusion or transurethral coagulation. CONCLUSIONS: Holmium laser prostatectomy was effective and safe for patients with PBNO, with elevated subjective patient satisfaction.