Waiting for HoLEP-outcomes when complications arise in the preoperative period

Surgery for benign prostatic hyperplasia (BPH), including holmium laser enucleation of the prostate (HoLEP), is often considered to be elective, leading to many patients waiting for intervention. Wait times for HoLEP can vary on many factors, but the incidence and impact of complications in this preoperative waiting period are unknown. We sought to uncover the outcomes of HoLEP in patients who experienced a complication while waiting for surgery.

We performed a retrospective review of a prospectively maintained database of patients who underwent HoLEP at a high-volume center between January 2021 and August 2023. Date of surgical case request placement, date of complication occurrence, and date of HoLEP were recorded. Preoperative, intraoperative, and postoperative characteristics were collected and analyzed. Statistical analysis was performed with SPSS software with p < 0.05 denoting significance.

We identified 918 patients in the database in this timeframe, with 74 experiencing a complication while waiting for HoLEP. Mean preoperative prostate volume was 122.7 ml. Complications included 8 cardiac and 37 urologic events. Complications were associated with a 31.2-day increase in wait time. Patients with cardiac complications waited 113.5 days (p = 0.013). Patients who had a complication while waiting were more likely to be on benign prostatic hyperplasia (BPH) medications, be catheter dependent, and have urinary tract infections (UTI) within 6 months of surgery. The 90-day postoperative complication rate was 31.5% in the complication group and 20.4% in the non-complication group. Patients who experienced a wait time complication were also more likely to have prolonged postoperative catheter duration and increased emergency room visits.

Patients with history of UTI and catheter dependence are more likely to experience a complication while waiting for HoLEP. Having a wait time complication can significantly delay surgery date by up to 30 days, and patients experiencing complication preoperatively are more likely to experience further complications postoperatively. Efforts are needed to expedite and improve access to necessary BPH procedures.