One-night catheter stay after Holmium laser enucleation of the prostate: a single-center comparative study

Holmium laser enucleation of the prostate (HoLEP) is an effective treatment for benign prostatic hyperplasia (BPH). This study aimed to assess the impact of catheterization duration on postoperative outcomes, focusing on re-catheterization rates and associated risk factors.

A retrospective analysis was conducted on patients who underwent HoLEP at our institution (June 2022-August 2024). Starting in November 2023, we decided to attempt catheter removal the morning after the procedure unless contraindicated. Patients were categorized into two groups based on catheterization duration: > 1 day (Group A) and ≤ 1 day (Group B). Perioperative variables, functional outcomes, and re-catheterization rates were compared between the groups. Multivariable logistic regression models were used to identify independent predictors of re-catheterization.

258 patients were analyzed. Baseline characteristics, including age, BMI, IPSS, Q_max, and PSA, were comparable between groups. Median prostate volume was larger in Group A (85 vs. 70.5 mL, p = 0.06) -though the difference bordered on statistical significance. Enucleation time was significantly longer in Group A (80 vs. 55 min, p < 0.001). Patients in Group A experienced higher re-catheterization rates (21.9 vs. 1.5%, p < 0.001) and longer hospitalization (2 vs. 1 day, p < 0.001). Multivariable analysis confirmed catheterization duration as the sole independent predictor of re-catheterization (p < 0.001). Factors such as prostate volume, post-void residual volume, and enucleation time were insignificant. Most re-catheterizations were due to urinary tract infections (16/30, 53%).

Early catheter removal after HoLEP is safe and effective, reducing re-catheterization risk without compromising outcomes. Early removal may also enhance postoperative recovery by minimizing infections.