Endourology Fellow Washington University School of Medicine
Introduction: Holmium laser enucleation of prostate (HoLEP) offers a size independent approach to the treatment of benign prostatic hyperplasia (BPH). Bladder neck contracture (BNC) is a known complication after endoscopic intervention for BPH. This study aims to evaluate the incidence and risk factors associated with the formation of postoperative BNC after HoLEP. Methods: A retrospective review was conducted from 2020 to 2022 of men undergoing HoLEP by a single surgeon. Exclusion criteria included patients with follow up of less than 1 month. Patients with postoperative BNC were identified, and Chi-square and Mann-Whitney U tests were used to test for significant associations between categorical and continuous variables of interest and bladder neck contracture respectively. Pre- and perioperative factors were compared between groups including catheter dependence, history of radiation, previous outlet procedures, concurrent procedures, laser type, enucleated gland weight, and energy usage. Results: A total of 184 men were identified for the study. An incidence of BNC occurred in 9% of patients (n = 17). On univariate analysis, enucleated gland weight was significantly associated with BNC (70 vs 38.9, p = 0.029), though this association was not seen on multivariate analysis. Amongst men with glands less than 40gm, 13.3% had BNCs. The presence of bladder stones at time of HoLEP was a significant risk factor associated with the development of BNC, as 17.6% of men with BNCs had bladder stones (p = 0.039). Urethral dilation was also significantly associated with BNC (11.8%, p = 0.023). Mean time to diagnosis of BNC was 6.5 months. Mean follow up was 6.5 months. Conclusions: Our study identified smaller gland size, as well as concurrent bladder stones and previous stricture disease, as significant risk factors for the development of BNC after HoLEP. This study underscores the importance of preoperative anatomical evaluation in patient counseling and discussion of individual risk factors. SOURCE OF Funding: none
