Assessing the outcome of Holmium Laser Enucleation of the Prostate (HoLEP) by age, prostate volume, and a history of blood thinning agents - report from a single-center series of >1,800 consecutive cases.

To assess perioperative outcomes of HoLEP in a real-world scenario and with a focus on demanding patient factors such as large prostate size, advanced patient age, and anticoagulation therapy (AT).

We retrospectively analysed HoLEP procedures at our institution between 2010-2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above groups median).

The study cohort consisted of 1,816 men with a median age of 71 years (IQR:66-76), a median prostate volume of 80 ml (IQR:58-105) and American Society of Anesthesiologists (ASA) score ≥3 in 618 men (34%). Median time of enucleation and morcellation were 43 min (IQR:31-60) and 10 min (IQR:6-18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien-Dindo grade ≥3b) occured in 61 (3.3%) of cases. The median time of catheterization was 2 days (IQR: 2-2), with prolonged catheterization occuring in 277 (15%) of cases. After adjustment, very large prostates (4th volume quartile (106-280ml) (OR:1.8, 95%CI:1.3-2.6, p=0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95%CI:1.4-3.6, p=0.037), low-dose acetylsalicyclic acid (OR:1.5, 95%CI:1.0-2.2, p=0.015), and a history of direct oral anticoagulation (OR:2.3, 95%CI:1.2-4.0, p=0.022), but not patient age, were independently associated with prolonged catherization.

We confirm HoLEP as safe and efficient; however, patients with very large prostates and patients with a history of anticoagulation therapy are at risk of prolonged catheterization.

Journal of endourology. 2020 Oct 12 [Epub ahead of print]

Philipp Gild, Lukas Lenke, Raisa Sinaida Pompe, Malte Wolfram Vetterlein, Tim Alexander Ludwig, Armin Soave, Felix Chun, Sascha A Ahyai, Roland Dahlem, Margit Fisch, Michael Rink, Christian Meyer, Andreas Becker

University Medical Center Hamburg-Eppendorf, 37734, Department of Urology, Martinistrasse 52, Hamburg, Germany, 20246; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Frankfurt, Frankfurt, Germany; ., University Medical Center Goettingen, Urology, Göttingen, Germany; ., University Medical Center Hamburg-Eppendorf, Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Urology, Martinistr. 52, Hamburg, Germany, 20246; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; ., University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany.

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