Holmium laser enucleation of the prostate (HoLEP) is currently one of the gold-standard surgical techniques for treating urinary symptoms associated with benign prostatic hyperplasia (BPH), particularly in patients with an enlarged prostate. Despite the excellent functional outcomes reported in the literature, the procedure can present a significant degree of complexity and is associated with a risk of perioperative and postoperative complications related to the patient’s demographic, anatomical, and clinical characteristics.
To clarify this point, our researchers analyzed data from 284 patients who underwent HoLEP at a high-volume center with over 15 years of experience with the technique; of these, the median prostate volume was approximately 87 ml, and 21% were taking anticoagulant or antiplatelet medications. All patients were followed for 12 months through clinical visits, laboratory and radiological tests, and telephone interviews, and postoperative complications were classified according to the Clavien-Dindo classification.
Our data confirm an extremely favorable safety profile associated with this procedure, with a complication rate lower than that reported in the literature, when the procedure is performed by experienced surgeons. In 72% of cases, no adverse events occurred during hospitalization or throughout the study’s observation period, while in 26% of cases, complications were mild (Clavien 1–2) and did not require further active treatment. Among the most frequent complications, fever (11%) and acute urinary retention due to a clot or pelvic spasm (8%) were noted in the immediate postoperative period, while in the post-surgical follow-up, urinary urgency (4%) and stress urinary incontinence (3.5%) were identified as the most common, though generally transient, symptoms.
Less than 2% of patients experienced severe complications (Clavien grade 3), and no cases of major adverse events (Clavien grade >4) were reported.
The statistical analysis also identified two major predictors of complications: advanced age and the presence of a urinary catheter prior to surgery. In particular, patients with a catheter have a fourfold higher risk of procedure-related adverse events.
These findings have significant clinical implications: when performed in high-volume centers with adequate experience, HoLEP is confirmed to be a safe and effective procedure. However, proper patient selection and careful management of the most vulnerable patients are essential to minimize the risk of complications and optimize surgical outcomes.
Capogrosso P, Fallara G, Pozzi E, Schifano N, Candela L, Costa A, et al. Rates and predictors of postoperative complications following Holmium laser enucleation of the prostate (HoLEP) at a high-volume center. Minerva Urol Nephrol. 2022;74(4):461-466. doi: 10.23736/S2724-6051.21.04315-9.
