Presented by: shayel bercovich MD, MPH
rabin medical center

Introduction

Holmium laser enucleation of the prostate (HoLEP) has emerged as a minimally invasive surgical technique that offers excellent outcomes and improved quality of life for patients suffering from symptomatic BPH. However, the impact of obesity on surgical outcomes and the overall efficacy of HoLEP in the management of BPH remains a subject of debate. We aimed to compare the surgical results, perioperative parameters, and postoperative complications of HoLEP in obese and non-obese patients.

Materials

We retrospectively assessed data of patients who underwent HoLEP from July 2016 to September 2023 in our institution. All the procedures were done by or in the presence of a senior Urologist. Patients were assessed as obese or non-obese by BMI greater or lower than 30. Obese patients were categorized in which morbid obesity was defined as a BMI of 40 or higher.

Results

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One hundred sixty-eight patients with BMI greater than 30 were compared to all 536 other patients. Patients’ demographics and clinical characteristics were similar, with a median age of 72 vs. 70 years, median prostate size of 100 vs. 110 CC, and percentage of indwelling catheter before surgery of 45% vs. 40% in non-obese and obese patients, respectively. No significant difference was found in the procedure length (median: 110 vs. 112 min), post-operative hospitalization length (median: 1 vs. 1 day), post-surgical urinary retentions (6% vs. 7%), or post-operative ER visits (10% vs. 10%), comparing obese to non-obese patients respectively. Sub-categorial analysis of obese patients showed no difference in the post-operative parameters; however, the procedure length was longer in the morbidly obese (BMI>40) patients (median: 135 vs. 110 min [p=0.02]).

Conclusion

HoLEP in obese patients is similar to HoLEP in non-obese patients regarding in-op and immediate post-op results. While obesity is a well-established risk factor for various health conditions and poor surgical outcomes, we showed that HoLEP in obese patients is effective and safe.

Funding

none

Lead Authors

hen hendel, MD
rabin medical center

Co-Authors

abed elhalim darawsha, MD
rabin medical center

sagi arieh shpitzer, MD
rabin medical center

michael frumer, MD
rabin medical center

yosi ventura, MD
rabin medical center

liran zieber, MD
rabin medical center

yaron ehrlich, MD
rabin medical center