HoLEP in patients with and without catheter-dependent acute urinary retention: surgical and functional outcomes HoLEP en los pacientes con y sin retención aguda de orina que precisa sondaje: resultados quirúrgicos y funcionales

Abstract

Holmium Laser Enucleation of the Prostate (HoLEP) is an effective treatment for benign prostatic obstruction; however, data on its outcomes in patients with acute urinary retention (AUR), particularly those who remained catheter-dependent until surgery, remain limited. This study compared HoLEP outcomes in patients with and without AUR. Methods: Data from 140 male patients aged 50-80 who underwent HoLEP were retrospectively and exploratorily analyzed. Patients were grouped as catheter-dependent AUR (Group-1) and non-AUR (Group-2). The primary comparison was Qmax at 6 months, while secondary comparisons included functional outcomes and perioperative/postoperative complications. Results: Thirty-four patients (24.3%) had catheter-dependent AUR. They were older (68.9 +/- 6.9 vs. 66.2 +/- 6.5 years) and had worse baseline IPSS (25[22-29] vs. 22[17-25]), quality of life (QoL; 5 [4-6] vs. 4 [3-5]), Qmax (0 vs. 8[5.6-10] mL/s), and PVR (400[197-560] vs. 100[60-150] mL) (p < 0.05). Perioperative parameters and complication rates were not significantly different between the groups. Following HoLEP, AUR patients showed greater improvements in Qmax (Delta 16[14-20.3] vs. 10 [7-15] mL/s), IPSS (Delta 16.5[10.8-22.3] vs. 11.5[6-17.3]), QoL (Delta 4 [3-5] vs. 3[1-3.3]), and PVR (Delta 326[128-502] vs. 62.5[26-120] mL) (p < 0.05). Although patients with catheter-dependent AUR demonstrated more pronounced improvements in functional outcomes, this was largely attributable to worse baseline parameters. No statistically significant differences were observed in postoperative outcomes between the groups. Notably, subjective measures (IPSS and QoL) improved more markedly in Group-1. Conclusions: HoLEP is an effective treatment option for catheter-dependent AUR patients, providing significant functional improvement. Preoperative catheterization until surgery does not negatively affect surgical efficacy or postoperative outcomes.