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
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