Rates and predictors of postoperative complications after Holmium laser enucleation of the prostate (HoLEP) at a...

Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure with a non-negligible risk of complications limiting its widespread adoption. We investigated rates and preoperative predictors of complications in a high-volume center with long-time experience.

Data from 284 patients treated with HoLEP between 2015 and 2017 were analyzed. Postoperative complications occurring up to 12 months after surgery were collected following the EAU guidelines recommendations. Procedure-specific complications were defined and graded by using the Clavien-Dindo (CD) system. Logistic regression analysis evaluated preoperative risk factors for postoperative complications.

Baseline prostate volume was (median, IQR) 87 (60, 120) ml. As a whole, in-hospital and after discharge complications were 19% and 11.6%, respectively, with a 28.6% overall rate at 12 months from surgery. Complications were graded as CD 1 (8% [22]), 2 (18.2% [52]) and 3 (1.8% [5]), respectively. Fever was the most frequently reported (11% of cases), followed by acute urinary retention (8%). At logistic regression analysis, older age (OR: 1.07; 95%CI: 1.01-1.12; P=0.01) and having an indwelling catheter before surgery (OR: 4.03; 95%CI 1.64-9.9; P=0.002) emerged as significant risk factors for post-HoLEP complications, after accounting for surgeon experience and baseline parameters.

HoLEP is a safe procedure in a high-volume center with less than 2% high-grade complications. Older patients with indwelling catheter deserve to be carefully managed due to a higher risk of postoperative complications.