Abstract
Purpose:
To assess perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in a real-world scenario and with a focus on demanding patient factors, such as large prostate size, advanced patient age, and anticoagulation therapy (AT).
Materials and Methods:
We retrospectively analyzed HoLEP procedures at our institution between 2010 and 2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above group's median).
Results:
The study cohort consisted of 1816 men with a median age of 71 years (interquartile range [IQR]: 66–76), a median prostate volume of 80 mL (IQR: 58–105), and American Society of Anesthesiologists score ≥3 in 618 men (34%). Median time of enucleation and morcellation was 43 minutes (IQR: 31–60) and 10 minutes (IQR: 6–18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien–Dindo grade ≥3b) occurred in 61 (3.3%) cases. The median time of catheterization was 2 days (IQR: 2–2), with prolonged catheterization occurring in 277 (15%) cases. After adjustment, large prostates (fourth volume quartile [106–280 mL]) (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.3–2.6, p = 0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95% CI: 1.4–3.6, p = 0.037), low-dose acetylsalicylic acid (OR: 1.5, 95% CI: 1.0–2.2, p = 0.015), and a history of direct oral anticoagulation (OR: 2.3, 95% CI: 1.2–4.0, p = 0.022), but not patient age, were independently associated with prolonged catheterization.
Conclusions:
We confirm HoLEP as safe and efficient; however, patients with large prostates and patients with a history of AT are at risk of prolonged catheterization.
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