Influence of preoperative indwelling urinary catheter on outcomes of high-power holmium laser enucleation for very large prostate (≥ 200 mL)

Purpose: to evaluate the impact of Indwelling Urinary Catheters (IUC) on perioperative and functional outcomes, as well as the safety profile, of High-Power HoLEP for the treatment of prostate gland volumes exceeding 200 cc. Methods: A retrospective analysis was conducted on 237 patients with prostate volumes > 200 cc who underwent HoLEP between January 2016 and December 2022. Patients were included based on specific criteria, such as an International Prostate Symptom Score (IPSS) > 7 and a maximum urinary flow rate (Qmax) < 15 mL/s. Patients were categorized into two groups: Group 1 included those with IUC prior to surgery, while Group 2 comprised patients without it. Results: A total of 237 patients with prostate volumes exceeding 200 cc underwent HoLEP, and were categorized into Group 1 (n = 63) and Group 2 (n = 174), with Group 1 exhibiting higher Charlson Comorbidity Index and BMI. Postoperative outcomes indicated a higher incidence of urinary tract infections in Group 1, as well as worse IPSS, Qmax, and PVR at 3 months; however, by the 1-year follow-up, both groups demonstrated comparable results. Longitudinal analysis revealed that both groups experienced significant functional and symptomatic improvements over time, with Group 2 showing rapid early gains that stabilized, whereas Group 1 exhibited continuous improvement from 3 months to 1 year. Conclusion: HoLEP is an effective treatment for very large prostate volumes in patients with IUC. Although these patients are at a higher risk for UTI and initial lower Qmax, these outcomes improve by one year.