Holmium laser enucleation of the prostate (HoLEP) is recognized as a gold standard treatment for benign prostatic hyperplasia (BPH), providing durable improvements in quality of life and symptomatology. However, a subset of patients continues to experience suboptimal voiding outcomes postoperatively. This study aims to identify preoperative predictors of poor voiding patterns, as objectively measured by maximum urinary flow rate (Q-max), following HoLEP.
We retrospectively analyzed 1121 patients who underwent HoLEP at McGill University Health Centre from January 2006 to December 2022. Inclusion required a minimum one-month follow-up with documented Q-max. Data collected included demographics, preoperative parameters (IPSS, PSA, prostate volume), operative details, and postoperative outcomes. Poor voiding was defined as a Q-max < 15 ml/sec at one month postoperatively. Bilateral stepwise regression identified candidate predictors, which were further evaluated using logistic regression.
The cohort had a mean age of 70.7 years (SD 8.3), mean prostate volume of 98.3 mL, and mean PSA of 6.7 ng/dL (SD 9.1). Preoperative medical therapy included alpha blockers (63.6%) and combination therapy (33%). Multivariate analysis revealed that advanced age (OR = 1.01 per year; 95% CI, 1.00-1.01; p = 0.017), diabetes mellitus (OR = 1.29; 95% CI, 1.03-1.62; p = 0.028), and preoperative combination BPH therapy (OR = 1.17; 95% CI, 1.02-1.34; p = 0.023) were independently associated with poor postoperative Q-max, whereas increased enucleated tissue weight was protective (OR = 0.998; 95% CI, 0.996-0.999; p = 0.005).
Advanced age, diabetes mellitus, and combination BPH therapy independently predict suboptimal voiding after HoLEP, highlighting the need for tailored preoperative evaluation and management strategies.
World journal of urology. 2025 Jul 30*** epublish ***
Abdulmalik Addar, Adel Arezki, Tarek Benzouak, Abdullah Al Zahrani, Hend Alshamsi, Abdullah Alahmari, Ahmed Ibrahim, Abdulghani Khogeer, Mélanie Aubé-Peterkin, Serge Carrier, Fadl Hamouche
Division of Urology, McGill University, Montreal, Canada. ., Division of Urology, McGill University, Montreal, Canada., Division of Urology, McGill University, Montreal, Canada. ., Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Division of Urology, McGill University, Montreal, Canada. .