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HoLEP for acute and non-neurogenic chronic urinary retention: how effective is it?
Tevita Aho1, William Finch2, Philippa Jefferson2
1Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. ahotribe@yahoo.co.uk.
Insights
Holmium laser enucleation of the prostate (HoLEP) offers high catheter-free rates (>98.5%) for urinary retention (UR) and is a durable treatment for high-pressure chronic urinary retention (HPCUR). However, first trial without catheter success is lower for non-neurogenic chronic urinary retention (NNCUR).
Area of Science:
- Urology
- Surgical Technology
- Prostate Health
Background:
- Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia.
- Urinary retention (UR), including acute (AUR) and non-neurogenic chronic (NNCUR), presents distinct challenges.
- Long-term renal function in patients with high-pressure chronic urinary retention (HPCUR) post-HoLEP requires evaluation.
Purpose of the Study:
- To assess catheter-free status at 3 months post-HoLEP for AUR and NNCUR.
- To compare short-term outcomes of HoLEP for UR versus lower urinary tract symptoms (LUTS).
- To report long-term serum creatinine (SC) in patients with HPCUR after HoLEP.
Main Methods:
- Retrospective analysis of the first 500 consecutive HoLEP cases performed by a single surgeon.
- UR defined by post-void residual volume or inability to void; urodynamic studies were not used for decision-making.
- Outcomes included catheter-free rates, trial without catheter (TWOC) success, and serum creatinine levels.
Main Results:
- 56% of patients (280/500) presented with UR (195 AUR, 85 NNCUR, 22 HPCUR).
- Catheter-free rates at 3 months exceeded 98.5% for both AUR and NNCUR.
- First TWOC success was lower in NNCUR (58.8%) compared to AUR (84.6%) and LUTS (87.7%).
- No significant deterioration in serum creatinine was observed long-term for HPCUR patients.
Conclusions:
- HoLEP achieves excellent catheter-free rates for AUR and NNCUR without pre-selection by urodynamic studies.
- HoLEP demonstrates durability for HPCUR, negating the need for routine renal function monitoring.
- NNCUR patients have a higher likelihood of failing their first TWOC post-HoLEP.
Purpose:
To determine catheter status within 3 months of holmium laser enucleation of the prostate (HoLEP) for acute and non-neurogenic chronic urinary retention (AUR and NNCUR), to compare short-term outcomes of HoLEP for urinary retention (UR) versus lower urinary tract symptoms (LUTS), and to report long-term serum creatinine (SC) after HoLEP for high-pressure chronic urinary retention (HPCUR).
Methods:
A prospectively maintained database of the first 500 consecutive HoLEP cases performed under the care of a single surgeon was analysed retrospectively. Urodynamic studies (UDS) did not play a role in the decision making process for those with UR. NNCUR was defined as painless, with post-void residual volume (PVR) greater than 300 ml in men able to void and initial catheter drainage > 1000 ml in men unable to void.
Results:
280/500 (56%) were in UR: AUR (195), and NNCUR (85) including 22 with HPCUR. The UR cohort were older with higher enucleated tissue weight [median (IQR); 72 years (66-79 year) and 56 g (29.8-86.3 g)], than the LUTS cohort [70 years (64-75 year) and 38 g (18-67 g)] (p < 0.001). 98.9% with AUR and 98.8% with NNCUR were catheter-free 3 months after HoLEP. There were no significant differences in transfusion rates, hospital stay, or time to first trial without catheter (TWOC) between the LUTS and UR cohorts, nor in international prostate symptom score and quality of life scores, maximum urinary flow rate, post void residual volume or urinary incontinence at 3 months. Patients with NNCUR were less likely to pass their first TWOC (58.8%) than those with AUR (84.6%) or LUTS (87.7%), p < 0.001. None with HPCUR had a clinically significant deterioration in SC at a median of 60 months (IQR 36-82 months).
Conclusion:
HoLEP has 3-month catheter-free rates in excess of 98.5% for AUR and NNCUR in patients not pre-selected by UDS. First TWOC is significantly more likely to fail after HoLEP for NNCUR than AUR or LUTS. HoLEP is a durable treatment for HPCUR and there is no need to monitor renal function to detect recurrence.
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