Presented by: Fabrice Henry MD
Cleveland Clinic Glickman Urological and Kidney Institute

Introduction

Overall infectious complications after holmium laser enucleation of the prostate (HoLEP) are low but the rates of infections between high- vs. low-risk patients is unknown.  We aimed to assess rates of infectious complications between high-risk vs. low-risk patients undergoing HoLEP.  We secondarily aimed to evaluate the effect of preoperative antibiotic duration on infection rates in high-risk patients.

Materials

Patients who underwent HoLEP at our institution were retrospectively reviewed. Patients were classified as “high risk” if they were catheter dependent at the time of surgery (indwelling or intermittent catheterization) or had a positive pre-operative culture within 2 weeks of surgery. The primary endpoint was any post-operative genitourinary infection within 30 days of HoLEP.  Within the high-risk group, long and short duration of antibiotics was defined as > 3 days and ≤ 3 days. Secondary endpoints included functional outcomes and prostate specific antigen.

Results

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190 patients met inclusion criteria. 61% of patients were classified as high risk. Of the high-risk patients, 59% received a long course of antibiotics, while 41% received a short course. Overall infection rates were 4.7%, with no significant difference between high- and low-risk patients or between long and short courses of antibiotics for high-risk patients. High-risk patients received a broader spectrum of preoperative antibiotics. 

Conclusion

A higher risk of postoperative infections after HoLEP may be mitigated by extended antibiotics. Larger, prospective randomized trials are needed to identify ideal antibiotic protocols for high-risk patients undergoing HoLEP.

Funding

None

Co-Authors

Nikhil Prahmod,
Cleveland Clinic Glickman Urological and Kidney Institute

Suruchi Ramanujan,
Case Western Reserve University College of Medicine

James Bena,
Cleveland Clinic Glickman Urological and Kidney Institute

Smita De, MD,PHD
Cleveland Clinic Glickman Urological and Kidney Institute