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Updated: Jun 1, 2025
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study
Clément Klein1, Julien Anract2, Ugo Pinar3
1Urology Department, CHU Bordeaux, Bordeaux, 33000, France. clement.klein@chu-bordeaux.fr.
Insights
Holmium laser enucleation of the prostate (HoLEP) is safe and effective for elderly patients with indwelling catheters. Most patients achieve spontaneous voiding post-surgery, with a mortality rate comparable to the general male population.
Area of Science:
- Urology
- Geriatric Medicine
- Surgical Innovation
Background:
- Elderly patients with indwelling catheters often face challenges with urinary retention.
- Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgical option.
- Evaluating HoLEP in very elderly patients (>85 years) with indwelling catheters is crucial.
Purpose of the Study:
- To assess the safety and efficacy of HoLEP in patients aged over 85 years requiring an indwelling catheter.
- To compare outcomes in very elderly patients with a younger control group.
Main Methods:
- Retrospective analysis of a bicentric HoLEP database (June 2012 - April 2020).
- Inclusion of patients with indwelling catheters and trial without catheter (TWOC) failure.
- Comparison between patients ≥85 years and controls <70 years.
Main Results:
- No significant difference in major complications or transfusion rates between groups.
- Higher rates of prolonged hospital stay and TWOC failure in the ≥85 group.
- One-year spontaneous voiding rate of 97% in the ≥85 group, comparable to controls (100%).
Conclusions:
- HoLEP demonstrates safety and efficacy in elderly patients (>85 years) with indwelling catheters.
- High rates of successful spontaneous voiding are achievable in this population.
- Mortality rates in the HoLEP group are comparable to the general male population of similar age.
Introduction:
This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC).
Methods:
We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence.
Results:
In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously.
Conclusion:
HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.
