Urology Research Fellow Sidney Kimmel Medical College at Thomas Jefferson University
Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting men and, historically, transurethral resection of the prostate (TURP) is considered the benchmark surgical treatment. Holmium laser enucleation of the prostate (HoLEP) has emerged as a size-independent endoscopic gold standard. HoLEP has significant advantages, but widespread practice is limited by a steep learning curve and is often limited to academic medical centers. We believe a review of common HoLEP complications and their management may further its adoption.
Methods: We performed a comprehensive retrospective chart review of patients who underwent HoLEP between 2013 and 2020 at our institution. There was data available for 820 patients. We assessed for 16 complications related to HoLEP and Clavien-Dindo classification grade II and above.
Results: The procedure was completed in 99% of patients and complication results are listed in Table 1. The average length of follow up was 1.7 years. 13.2% of patients had prior outlet surgery. The most common complication was infection (4.8%). There was a transfusion rate of 2.8%. Stricture rates were 1.5% for meatal stenosis, 4.3% for urethral stricture, and 0.9% for bladder neck contracture. Stress urinary incontinence (SUI) immediately following surgery was common. However, it was transient in most patients and improved over time. Persistent SUI, defined as lasting greater than 1 year, was 1.3%. 2.1% of patients required ICU admission (over half of which were due to fluid overload and/or associated electrolyte imbalances) and almost all of whom were transferred out of the ICU within 24 hours. Clavien-Dindo complication rates were 1.8% for grade II, 2.0% for grade III, and 2.1% for grade IVa. There were no patient deaths.
Conclusions: There is an overall low incidence of complications associated with HoLEP and most are low grade and managed easily. As a high-volume referral center for HoLEP, the patients we operate on represent the full range of surgical complexity and our review offers realistic expectations of pertinent complications that may arise. We also provide guidance on how to manage these complications. With this knowledge, we hope there may be a shift in the urology community towards further implementing this effective and safe surgery for patients.