Predictors of Failed Same-Day Catheter Removal After Holmium Laser Enucleation of the Prostate



      To determine factors associated with failure of same-day trial of void (SDTOV) following holmium laser enucleation of the prostate (HoLEP).


      HoLEP is increasingly utilized for patients with benign prostatic hyperplasia. Advancements in technology have improved operative efficiency and hemostasis making same-day, catheter-free discharge possible.


      We conducted a retrospective review on 190 patients undergoing HoLEP from July, 2021 to January, 2022 by a single center. We assessed pre- and intra-operative variables associated with our primary outcome: failure of same-day catheter removal. Post-operative complications and outcomes at a ≤7 days and 3-month follow up were examined. Continuous and categorical variables were analyzed using unpaired t-tests (Mann Whitney) and chi-square, respectively. Univariate and multivariable logistic regression models were fitted to examine the associations of failed SDTOV.


      Of 190 candidates for a SDTOV, 90% (171/190) were successful. We found no difference between SDTOV success and failures with regards to age, comorbidities, presence of pre-operative urinary retention, anesthesia factors, operative time, volume resected, enucleation time, and morcellation time (all P>0.05). Pre-operatively, 26.3% (50/190) were on antiplatelet and 6.3% (12/190) were on anticoagulation. While pre-operative antiplatelet therapy was not associated with SDTOV failure (P=0.78), pre-operative anticoagulation use was (4.7% vs. 21.1%, P=0.021). Patients who continued anticoagulation through surgery had the highest rate of SDTOV failure (2.3% (4/171) vs. 15.8% (3/19), P=0.023). For those with successful SDTOV, 4.1% (7/171) required catheterization following discharge. At 3 months, no patient required catheterization.


      On the day of surgery, patients eligible for SDTOV successfully voided 90% of the time. History of preop anticoagulation, whether continued or held, increased SDTOV failure.
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        • Launer BM
        • McVary KT
        • Ricke WA
        • Lloyd GL.
        The rising worldwide impact of benign prostatic hyperplasia.
        BJU Int. 2021; 127: 722-728
        • Cornu JN
        • Ahyai S
        • Bachmann A
        • et al.
        A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: An update.
        Eur Urol. 2015; 67: 1066-1096
        • Boeri L
        • Capogrosso P
        • Ventimiglia E
        • et al.
        Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy.
        Eur Urol Focus. 2020; 6: 720-728
        • Rivera M
        • Krambeck A
        • Lingeman J.
        Holmium laser enucleation of the prostate in patients requiring anticoagulation.
        Curr Urol Rep. 2017; 18: 77
        • Large T
        • Nottingham C
        • Stoughton C
        • Williams J
        • Krambeck A.
        Comparative study of Holmium Laser Enucleation of the prostate with MOSES enabled pulsed laser modulation.
        Urology. 2020; 136: 196-201
        • Anderson BB
        • Heiman J
        • Large T
        • Lingeman J
        • Krambeck A.
        Trends and perioperative outcomes across major benign prostatic hyperplasia procedures from the ACS-NSQIP 2011-2015.
        J Endourol. 2019; 33: 62-68
        • Fallara G
        • Capogrosso P
        • Schifano N
        • et al.
        Ten-year follow-up results after Holmium Laser Enucleation of the prostate.
        Eur Urol Focus. 2021; 7: 612-617
        • Agarwal DK
        • Rivera ME
        • Nottingham CU
        • Large T
        • Krambeck AE.
        Catheter removal on the same day of Holmium Laser Enucleation of the prostate: Outcomes of a Pilot Study.
        Urology. 2020; 146: 225-229
        • Agarwal DK
        • Large T
        • Tong Y
        • et al.
        Same day discharge is a successful approach for the majority of patients undergoing Holmium Laser Enucleation of the prostate.
        Eur Urol Focus. 2021; (S2405-4569(20)30320-5)
        • Gauhar V
        • Gilling P
        • Pirola GM
        • et al.
        Does MOSES technology enhance the efficiency and outcomes of standard Holmium Laser Enucleation of the prostate? Results of a Systematic Review and Meta-analysis of Comparative Studies.
        Eur Urol Focus. 2022; (S2405-4569(22)00036-0)
        • Stout TE
        • Borofsky M
        • Soubra A.
        A visual scale for improving communication when describing gross hematuria.
        Urology. 2021; 148: 32-36
        • Foster HE
        • Dahm P
        • Kohler TS
        • et al.
        Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline Amendment 2019.
        J Urol. 2019; 202: 592-598
        • Assmus MA
        • Large T
        • Lee MS
        • Agarwal DK
        • Rivera ME
        • Krambeck AE.
        Same-day ischarge following Holmium Laser Enucleation in patients assessed to have large gland prostates (≥175 cc).
        J Endourol. 2021; 35: 1386-1392
        • Slade A
        • Agarwal D
        • Large T
        • Sahm E
        • Schmidt J
        • Rivera ME.
        Expanded criteria same day catheter removal following Holmium Laser Enucleation of the Prostate (HoLEP).
        J Endourol. 2022;