Presented by: Nicholas Dean MD
Northwestern University

Introduction

BPH can be a common cause of GH. Men experiencing BPH-related GH, especially those on therapeutic anticoagulation (AC), often require admission secondary to urinary retention and blood loss. The objective of our study was to examine the safety and efficacy of performing eHoLEP at time of cystoscopy and clot evacuation in men presenting with refractory GH in the setting of BPH.

Materials

We retrospectively identified men who underwent eHoLEP for prostate glands > 80 cc with refractory GH from our BPH database. Continuous variables were expressed as a mean (range). All HoLEP procedures were performed with MOSES 2.0 laser technology.

Results

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We identified 11 patients who underwent eHoLEP between Jan 2021 and April 2023. The mean patient age was 77.0 (58-92) years and the mean pre-operative prostate size was 262.8 (126-550) cc. Most patients were on baseline therapeutic AC (63.6%, n=7/11) and had pre-admission indwelling catheters (90.9%, n=10/11). AC could not be held in 18.2% (n=2/11) of patients. The mean duration of inpatient treatment for GH prior to eHoLEP was 4.7 (1-14) days and 45.5% (n=5/11) of patients had transfusion-dependent hematuria. At least one attempt at cystoscopy and clot evacuation failed in 36.4% (n=4/11) of patients. The mean procedure duration was 109.7 mins (65-182) and a mean 204.4 g (116-393) of tissue was resected. The mean post-operative LOS was 2.2 days (1-4). Most patients were discharged without a foley catheter (81.8%, n=9/11) and all patients are catheter free at last follow-up. The 30-day complication rate was 27.3% (n=3/11), with all being CD grade 1 or 2. No patient required re-admission or re-operative intervention.

Conclusion

HoLEP can safely be offered to men admitted with refractory BPH-related GH and is associated with satisfactory post-operative outcomes in a co-morbid cohort. Definitive emergency BPH treatment may hasten patient recovery and has the potential to reduce morbidity associated with treatment delays.

Funding

None

Co-Authors

Jenny Guo, MD
Northwestern University

Eric Li, MD
Northwestern University

Perry Xu, MD
Northwestern University

Matthew Lee, MD
Northwestern University

Amy Krambeck, MD
Northwestern University