Does Severity of Chronic Urinary Retention as Estimated by Preoperative Residual Urine Estimation Negatively Impact the Outcome of Holmium Laser Enucleation of the Prostate?

Objective: To evaluate the influence of preoperative post-void residual (PVR) volume on the outcomes of Holmium Laser Enucleation of the Prostate (HoLEP). Long-term bladder obstruction can impair bladder contractility, which has been linked to failure to improve lower urinary tract symptoms (LUTS) after bladder outlet procedures. Elevated PVR constitutes a proxy for chronic retention and detrusor underactivity that can be non-invasively determined in office.

Methods: We evaluated men undergoing "en-bloc" HoLEP from July 2017 to August 2022 from our prospectively maintained database. PVR, prostate-specific antigen, International Prostate Symptom Score (IPSS) and uroflowmetry were assessed before surgery, at 3 months, 6 months and 1 year post- operatively. Patients' clinical characteristics and outcomes were compared according to preoperative PVR measurement by Group 1 (<100 mL), Group 2 (101-300 mL), Group 3 (301-600 mL), and Group 4 (>600 mL).

Results: We included 318 men and found no significant differences between groups regarding clinical or perioperative characteristics including operative time, resected volume, catheter time, and complications. Post-operative improvement in voiding parameters was found to be similar in all 4 groups up to 1 year of follow-up.

Conclusion: Severity of chronic urinary retention did not impact the outcomes of HoLEP, which provided great improvement in voiding parameters to men with LUTS secondary to benign prostatic hyperplasia, with no significant differences in outcomes between patient with preoperative PVR <100 mL or >600 mL. These findings should assist in reassuring patients with large bladder capacity that HoLEP can provide them with excellent functional voiding outcomes.