Objective: To quantify phase-specific operative efficiency in holmium laser enucleation of the prostate (HoLEP) and assess the association between comorbidity burden and efficiency metrics. Material and Methods: This single-center retrospective cohort included HoLEP cases performed between January 2023 and June 2025. Of 574 screened patients, 349 met eligibility criteria. Efficiency was calculated as enucleation efficiency (g/min; primary outcome), morcellation efficiency (g/min), and overall extraction efficiency (g/min). Associations were evaluated using multivariable linear regression models after natural log transformation of skewed efficiency outcomes, adjusted for age, log-transformed enucleated tissue weight, and prostate-volume (PV) stratum. Results: Median age was 67 years and 67.9% had ≥1 comorbidity. Median enucleated tissue weight was 53.0 g; median enucleation efficiency was 1.12 g/min, morcellation efficiency 7.00 g/min, and overall extraction efficiency 0.96 g/min. Enucleation efficiency increased across PV strata (0.86 to 1.75 g/min; p

The incremental value of PI-RADS for predicting adverse pathology at radical prostatectomy in men diagnosed through systematic biopsy remains uncertain. We assessed whether PI-RADS improves discrimination beyond age, MRI-derived prostate-specificantigen density (PSAD), biopsy Grade Group, and quantitative biopsy tumour burden. This retrospective study included 284 men undergoing 1.5-T mpMRI, systematic biopsy, and radical prostatectomy between January 2020 and January 2026. Adverse pathology comprised prostatectomy Grade Group ≥ 3 and/or stage ≥ pT3a. Three logistic models were compared: age/PSAD/biopsy grade/tumour burden; age/PSAD/PI-RADS; and their combination. Internal validation used 2000 bootstrap samples. Adverse pathology occurred in 143 patients (50.4%). Apparent AUCs were 0.790 (95% CI 0.737–0.843), 0.713 (0.653–0.773), and 0.799 (0.747–0.851); optimism-corrected AUCs were 0.781, 0.703, and 0.787. Adding PI-RADS ≥ 4 yielded an adjusted OR of 1.996 (95% CI 1.150–3.465) and an apparent AUC difference of 0.009 (95% CI −0.015 to 0.033; descriptive DeLong p = 0.469). The combined model had a corrected calibration slope of 0.915 and Brier score of 0.187. PI-RADS from routine 1.5-T mpMRI was independently associated with adverse pathology, but its incremental discrimination beyond clinical and systematicbiopsy variables was small and uncertain. These findings concern a surgery-selected systematicbiopsy pathway, do not estimate the overall value of MRI, and require external validation.