Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

Abstract

ObjectivePatients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP.Materials and Methods336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups.ResultsThe mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05).ConclusionsDe novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

Holmium Laser Enucleation versus Transurethral Resection in Patients with Benign Prostate Hyperplasia: An Updated Systematic Review with Meta-Analysis and Trial Sequential Analysis

“…Subsequently, HoLRP combined with transurethral tissue morcellation evolved into HoLEP. Since then, many studies on this issue have been conducted with different or even contradictory results [4] – [6] . Therefore, whether HoLEP is non-inferiority, equivalence, or superiority to TURP remains unclear.…”

A Modified Technique of Thulium Laser Enucleation for Benign Prostatic Hyperplasia With Non-morcellator Approach

“…All these reasons can result in several morbidities, including bladder neck false passage as well as ureteral orifice and bladder mucosal injuries (8,9,18). Besides, some researches reported that during the morcellation the bladder is distended to greater than maximal bladder capacity and is likely to result in postoperative voiding difficulties (19).…”

The Learning Curves for Laser Application in Urology Procedures: Review of the Literature

“…28 De Novo Urinary Retention De novo urinary retention is related to over-distention of the bladder throughout morcellation or myogenic damage to the detrusor muscle. 36 Therefore, it is not useful to predict the learning curve of HOLEP. 36 Trifecta -Pentafecta "Trifecta has been defined as HOLEP procedure done within 90 minutes without any change to TURP, pentafecta has been reached when patients meet the trifecta criteria without postoperative complications or stress urinary incontinence".…”

“…36 Therefore, it is not useful to predict the learning curve of HOLEP. 36 Trifecta -Pentafecta "Trifecta has been defined as HOLEP procedure done within 90 minutes without any change to TURP, pentafecta has been reached when patients meet the trifecta criteria without postoperative complications or stress urinary incontinence". 19 The learning curve has been reached when the urologist could perform four consecutive HOLEP procedures and reach the trifecta or pentafecta criteria.…”