Delayed Urinary Retention After Holmium Laser Enucleation of Prostate

To identify modifiable perioperative risk factors associated with delayed urinary retention (DUR) that occurs after a successful same-day trial of void (SDTOV) in patients undergoing holmium laser enucleation of prostate (HoLEP).

Our institution prospectively maintains an institutional review board-approved single surgeon database of HoLEP procedures from which we identified patients with DUR after passing SDTOV. Exclusion criteria included the first 50 cases (due to the surgeon's learning curve), patients with failed SDTOV, and clot retention. Using SPSS 26 statistical software, we analyzed various peri-operative factors in association with our primary outcome, DUR, using unpaired t tests for continuous variables and chi-squared analysis for categorical variables. Multivariate logistic regression was used to assess several preoperative and operative variables in association with DUR (P <.05 as significant).

Five hundred HoLEPs were performed from Jan 2020-Aug 2024. 18 (5.17%) of the 348 patients included had DUR. We found no significant differences in age, body mass index, American society of anesthesiologists, comorbidities, preoperative prostate size, or medication use between patients who did and did not have DUR. On multivariate logistic regression, intraoperative urethral dilation (25.8% cases) and postoperative continuous bladder irrigation (7.7% cases) were significantly associated with DUR (p<0.05).

Intraoperative urethral dilation and postoperative continuous bladder irrigation were significant predictors of non-clot DUR. Therefore, surgeries involving these contributors warrant additional postoperative patient counseling and consideration of discharge with catheter to decrease morbidity and cost from unplanned encounters for catheter replacement.