Presentation Authors: Philipp Gild*, Raisa Pompe, Malte W. Vetterlein, Valentin Maurer, Tim A. Ludwig, Phillip Marks, Tabea Ernst, Ihab Daoud, Lukas Lenke, Roland Dahlem, Margit Fisch, Philip Reiss, Michael Rink, Christian P. Meyer, Hamburg, Germany, Andreas Becker, Frankfurt, Germany
Introduction: HoLEP is recommended by AUA guidelines as size independent gold standard for the treatment of obstructive benign prostate hyperplasia. As such, we aimed to report on perioperative outcomes and to identify predictors of prolonged postoperative catheterization time in our large single centre experience.
Methods: We retrospectively reviewed 2,131 men undergoing HoLEP at our institution between 2006-2015. Standard pre-, intra- and postoperative characteristics were analysed, while multivariable logistic regression models (MVA) aimed to identify predictors of prolonged catheterization (defined as being above groups median).
Results: Median age and prostate volume were 71 years (Interquartile range (IQR):66-76) and 77 ml (IQR:56-102), respectively. 465 (21.82%) patients received concomitant low-dose Aspirin, therapeutic low-weight molecular Heparin was present in 123 (5.77%), direct oral anticoagulant (DOAC) use was present in 35 (1.64%) of men. Median time of enucleation and morcellation, specimen weight, and reduction in haemoglobin (Hb Delta) were 51 min (interquartile range (IQR):38-67), 10 min (IQR:6-17), 50 gr (IQR:29.7-76.0), 1.2 mg/dl (IQR:0.6-1.9). 58 (2.72%) patients experienced a Clavien-Dindo Complication â‰¥3, median days of catheterization and hospitalization were 2 days (IQR:2-2) and 4 days (IQR:4-5). 450 (21.1%) of patients experienced prolonged catheterization. Preoperative versus postoperative presence of indwelling catheter, postvoiding residual (PVR), Qmax, and voiding time, were 31.68% (n=675) vs. 8.17% (n=174), p < 0.001; 100 ml (IQR:60-200) vs. 25.9 ml (Standard deviation (SD): 68.7ml), p < 0.001; 9.9 ml/s (IQR:7-13.8) vs. 21.4 ml/s (IQR:15-30), p=0.003; 44 s (IQR:29.0-65.51) vs. 26.25 s (IQR:20-36.12), p=0.003.On MVA, age (OR:1.03,95% Confidence Interval(CI):1.01-1.04), ASA Score (OR:1.3, 95%CI:1.05-1.61), prostate volume >150 ml (OR:1.9, 95%CI:1.08-3.32) and DOACs (OR:2.49, 95%CI:1.18-5.23), were the only predictors of prolonged catheterization.
Conclusions: Our decade long experience confirms HoLEP as an efficacious treatment for BPH with a low complication rate. Patients with very large prostates and patients treated with DOACs are at highest risk for prologend catheterization.