Comparison of HoLEP Outcomes Between Catheterized and Non-Catheterized Patients: A Propensity Score-Matched Analysis

To evaluate the impact of preoperative urinary retention on perioperative and early postoperative outcomes following Holmium Laser Enucleation of the Prostate (HoLEP), using a balanced comparison between catheterized and non-catheterized patients.

This retrospective cohort study included patients who underwent HoLEP for benign prostatic hyperplasia at a tertiary center between January 2024 and July 2025. Patients were stratified into two groups based on the presence of acute or chronic urinary retention requiring preoperative catheterization. Propensity score matching (1:1) was performed using age, BMI, coronary artery disease, PSA, INR, platelet count, anticoagulant/antiplatelet use, and prostate volume, yielding 57 matched patients per group. Perioperative parameters, complications (Clavien-Dindo), and early functional outcomes were compared.

A total of 114 matched patients were analyzed. Baseline demographic and clinical characteristics were comparable between groups. Catheterized patients demonstrated significantly longer operative (p = 0.013) and enucleation times (p = 0.012). Postoperative hematocrit decline (p = 0.016), catheterization duration (p = 0.001), and hospitalization time (p = 0.012) were all greater in catheterized patients. The overall complication rate was higher in the catheterized group (p = 0.041), although individual adverse events were infrequent. Despite these differences, one-month functional outcomes (IPSS, Qmax, PVR) were similar between groups (all p > 0.05).

Preoperative urinary retention is associated with increased operative complexity and higher rate of early complications after HoLEP; however, early functional recovery remains comparable to that of non-catheterized patients. HoLEP remains an effective treatment across varying obstruction severities, though catheter-dependent patients may benefit from optimized perioperative management.