Presented by: Gherman Creiderman MD
Rabin Medical Center

Introduction

Patients with indwelling catheters (IC) due to chronic urinary retention constitute a large subgroup of individuals undergoing surgical treatment for benign prostatic hyperplasia. Previously, both high post-void residual (PVR) volume and long-term catheterization were regarded as indicators of increased risk for perioperative complications and surgical outcomes. In this study, we compare the complication rates and treatment success of holmium laser enucleation of prostate (HoLEP) in the (IC) group with patients treated for lower urinary tract symptoms (LUTS) without catheter.

Materials

We retrospectively analyzed data from 704 patients who underwent (HoLEP) at our institution between 2016 and 2022. We compared patient cohorts with and without (IC). All surgeries were performed by senior urologists at different stages of the learning curve using a high-power holmium laser (Lumenis/Quanta). Patients with (IC) received perioperative antibiotics based on culture results. Those with negative cultures received a combination of penicillin and an aminoglycoside in the operating room according to the institution policy. Treatment success was defined as a successful trial to void after surgery, with no need for catheter placement upon discharge.

Results

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Out of 704 patients, 309 (44%) had (IC). Patients with (IC) were older with higher enucleated tissue weight [mean±SD; 74 years± 8.5 and 92 g± 44.8] than LUTS patients [70.4 years± 7.08 and 81.1 g± 38.6] (p<0.01). The median (PVR) prior to surgery in the (IC) cohort was 875cc (357.5-1200), compared to 123cc (46-233.2) in the (LUTS) cohort. Urinary culture results were positive in 57.3% of (IC) patients, compared to 9.4% in the (LUTS) cohort. Both groups had similar postoperative catheter duration and hospitalization time, with a median of 1 day for both parameters. The (PVR) on discharge was lower in the (LUTS) group - 51.5 cc (27.7-90.25) vs 70 cc (36.2-124) (p<0.001). The febrile urinary tract infection rate was higher in the (IC) group compared to the LUTS group – 12 (3.8%) vs 4 (1%) (p=0.01). There was no statistically significant difference in the percentage of patients discharged with a catheter (13 [4.2%] in (IC) vs 11 [2.8%] in (LUTS) group), urinary retention rate, emergency room visits, and the rate of rehospitalization after discharge.

Conclusion

(HoLEP) in patients with (IC) is a safe procedure with a high success rate, comparable to that of patients with (LUTS). It provides patients with chronic urinary retention and high preoperative (PVR) with an opportunity to void spontaneously with low residuals on the next day after surgery. The higher potential for infection complications should be addressed through proper perioperative antibiotic treatment.

Funding

None 

Co-Authors

Yaron Ehrlich, MD
Rabin Medical Center

Abd Elhalim Darawsha, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

Michael Frumer, MD
Rabin Medical Center

Sagi Shpitzer, MD
Rabin Medical Center

Muhammad Krenawi, MD
Rabin Medical Center

Tomer Weizman, MD
Rabin Medical Center

Shayel Bercovich, MD
Rabin Medical Center

Nadav Dekel, MD
Rabin Medical Center

Hadar Tamir, MD
Rabin Medical Center

Tal Wax, MD
Rabin Medical Center

Tomer Hasdai, MD
Rabin Medical Center

Yossi Ventura, MD
Rabin Medical Center

Niv Segal, MD
Rabin Medical Center

Hen Hendel, MD
Rabin Medical Center

Liran Zieber, MD
Rabin Medical Center

Iyad Khamaisi, MD
Rabin Medical Center

David Lifhshitz, MD
Rabin Medical Center

Dmitry Enikeev, MD
Medical University of Vienna

Gherman Creiderman, MD
Rabin Medical Center