Metabolic syndrome is associated with postoperative complications after holmium laser enucleation of the prostate

To compare postoperative complication rates of patients with metabolic syndrome (MetS) with patients without MetS after holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH).

We retrospectively reviewed patients aged >40 years who underwent HoLEP at our institution from 2007 to 2022. Criteria for MetS were diagnoses of at least three of the following: diabetes mellitus, hypertension, hyperlipidaemia, or obesity (body mass index ≥30 kg/m²). Uni- and multivariable logistic regression were used to compare the likelihood of immediate, 30-day, and 90-day complications between groups.

A total of 1500 patients were included with a median (interquartile range) age of 70 (65-76) years. Patients with MetS were more likely to develop complications at both 30 and 90 days, including urinary incontinence, irritative voiding symptoms, and bleeding (P < 0.001). After adjusting for potential confounders, patients with MetS had a greater than three times odds of both 30- and 90-day complications compared to patients without MetS (30-day adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 2.21-5.01, P < 0.001; and 90-day aOR 3.64, 95% CI 2.49-5.31, P < 0.001).

Metabolic syndrome was associated with a three-fold likelihood of 30- and 90-day complications after HoLEP. This could be an important factor to consider in preoperative counselling and patient selection.