ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 August;74(4):461-6

DOI: 10.23736/S2724-6051.21.04315-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Rates and predictors of postoperative complications after Holmium laser enucleation of the prostate (HoLEP) at a high-volume center

Paolo CAPOGROSSO ^{1, 2}, Giuseppe FALLARA ^{1, 3}, Edoardo POZZI ³, Nicolò SCHIFANO ^{1, 3}, Luigi CANDELA ^{1, 3}, Antonio COSTA ^{1, 3}, Luca BOERI ^{1, 4}, Federico BELLADELLI ³, Walter CAZZANIGA ^{1, 3}, Vincenzo SCATTONI ¹, Andrea SALONIA ^{1, 3} ✉, Francesco MONTORSI ^{1, 3}

¹ Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ² Department of Urology, Circolo Hospital and Macchi Foundation, Varese, Italy; ³ IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁴ Department of Urology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure with a non-negligible risk of complications limiting its widespread adoption. We investigated rates and preoperative predictors of complications in a high-volume center with long-time experience.
METHODS: Data from 284 patients treated with HoLEP between 2015 and 2017 were analyzed. Postoperative complications occurring up to 12 months after surgery were collected following the EAU guidelines recommendations. Procedure-specific complications were defined and graded by using the Clavien-Dindo (CD) system. Logistic regression analysis evaluated preoperative risk factors for postoperative complications.
RESULTS: Baseline prostate volume was (median, IQR) 87 (60, 120) ml. As a whole, in-hospital and after discharge complications were 19% and 11.6%, respectively, with a 28.6% overall rate at 12 months from surgery. Complications were graded as CD 1 (8% [22]), 2 (18.2% [52]) and 3 (1.8% [5]), respectively. Fever was the most frequently reported (11% of cases), followed by acute urinary retention (8%). At logistic regression analysis, older age (OR: 1.07; 95%CI: 1.01-1.12; P=0.01) and having an indwelling catheter before surgery (OR: 4.03; 95%CI 1.64-9.9; P=0.002) emerged as significant risk factors for post-HoLEP complications, after accounting for surgeon experience and baseline parameters.
CONCLUSIONS: HoLEP is a safe procedure in a high-volume center with less than 2% high-grade complications. Older patients with indwelling catheter deserve to be carefully managed due to a higher risk of postoperative complications.

KEY WORDS: Holmium; Complications; Urology