Presented by: Tevita Aho FRACS(Urol)
Cambridge University Hospitals NHS Foundation Trust

Introduction

Little is known about the outcomes of HoLEP for the subtypes of urinary retention (UR): Acute (AUR = painful UR of any volume with relief on catheterisation) and non-neurogenic chronic (NNCUR = painless UR with PVR > 300ml in men able to void and painless with > 1,000ml on initial catheterisation in men unable to void).

Materials

A prospectively maintained database of the first 500 HoLEP cases performed under the care of a single surgeon was used to evaluate the three month post-operative catheter status of patients with pre-operative UR. Long-term serum creatinine was evaluated for those with high pressure chronic urinary retention (HPCUR = painless UR with associated renal dysfunction that improves following catheterisation).

Results

,

280/500 (56%) had pre-operative UR, of which 195 had AUR and 85 NNCUR, including 22 with HPCUR. Urodynamic assessment did not play a role in the surgical decision-making process for those with UR. 98.9% of those with AUR and 98.8% with NNUR were catheter-free three months following HoLEP. Those with NNCUR were statistically less likely to pass their first post-operative trial without catheter (58.8%) compared to those with AUR (84.6%) and those undergoing HoLEP. for lower urinary tract symptoms (87.7%). No patients with HPCUR had a clinically significant deterioration in serum creatinine at a median of 60. months (IQR 36-82 months).

Conclusion

HoLEP has excellent catheter-free outcomes for those with pre-operative UR in those not pre-selected by urodynamic assessment. It is a durable long-term treatment for those with HPCUR.

Funding

Nil

Lead Authors

Sophia Cashman, MRCS
Nottingham NHS Foundation Trust

Co-Authors

Fanourios Georgiades, MRCS
Cambridge University Hospitals NHS Foundation Trust