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

Caglar Dizdaroglu1, Ufuk Caglar1, Arda Meric2

  • 1Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.

Lower Urinary Tract Symptoms
|August 13, 2026
PubMed

Insights

Preoperative urinary retention increases Holmium Laser Enucleation of the Prostate (HoLEP) complexity and complications. However, early functional outcomes after HoLEP are similar for catheterized and non-catheterized patients.

Area of Science:

  • Urology
  • Surgical Outcomes
  • Benign Prostatic Hyperplasia Management

Background:

  • Preoperative urinary retention is a common complication of benign prostatic hyperplasia (BPH).
  • Holmium Laser Enucleation of the Prostate (HoLEP) is an effective treatment for BPH, but its outcomes in patients with preoperative urinary retention require further investigation.
  • Understanding the impact of preoperative urinary retention on HoLEP outcomes is crucial for optimizing patient management.

Purpose of the Study:

  • To assess the effect of preoperative urinary retention on perioperative and early postoperative outcomes after HoLEP.
  • To compare outcomes between patients requiring preoperative catheterization due to urinary retention and those who do not.
  • To evaluate the safety and efficacy of HoLEP in patients with varying degrees of bladder outlet obstruction.

Main Methods:

  • Retrospective cohort study of 114 patients undergoing HoLEP for BPH.
  • Patients were divided into two groups: those with preoperative urinary retention (catheterized) and those without (non-catheterized).
  • Propensity score matching (1:1) was used to control for baseline differences, followed by comparison of perioperative parameters, complications (Clavien-Dindo), and early functional outcomes.

Main Results:

  • Catheterized patients experienced significantly longer operative and enucleation times.
  • Higher rates of postoperative hematocrit decline, longer catheterization duration, and increased hospitalization time were observed in the catheterized group.
  • While the overall complication rate was higher in catheterized patients, one-month functional outcomes (IPSS, Qmax, PVR) were comparable between the groups.

Conclusions:

  • Preoperative urinary retention is linked to increased operative complexity and early complications following HoLEP.
  • Despite these challenges, HoLEP demonstrates comparable early functional recovery for both catheterized and non-catheterized patients.
  • HoLEP is a viable treatment for BPH across obstruction severities, with potential benefits from optimized perioperative care for catheter-dependent individuals.
Abstract

Keywords:
benign prostatic hyperplasiaholmium laser enucleationpropensity score matchingurinary retentionurinary tract symptoms

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