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Minerva Urology and Nephrology 2021 Apr 22

DOI: 10.23736/S2724-6051.21.04315-9


lingua: Inglese

Rates and predictors of postoperative complications after Holmium laser enucleation of the prostate (HoLEP) at a high-volume center

Paolo CAPOGROSSO 1, 2, Giuseppe FALLARA 1, 3, Edoardo POZZI 3, Nicolò SCHIFANO 1, 3, Luigi CANDELA 1 ,3, Antonio COSTA 1, 3, Luca BOERI 1, 4, Federico BELLADELLI 3, Walter CAZZANIGA 1, 3, Vincenzo SCATTONI 1, Andrea SALONIA 1, 3 , Francesco MONTORSI 1 ,3

1 Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2 Department of Urology, Ospedale di Circolo & Fondazione Macchi, Varese, Italy; 3 University Vita-Salute San Raffaele, Milan, Italy; 4 Department of Urology, Foundation IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy


BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure with a non-negligible risk of complications limiting its widespread adoption. We investigated rates and pre-operative predictors of complications in a high volume center with long-time experience.
METHODS: Data from 284 patients treated with HoLEP between 2015 and 2017 were analysed. Postoperative complications occurring up to 12 months after surgery were collected following the EAU guidelines recommendations. Procedure-specific complications were defined and graded by using the Clavien-Dindo (CD) system. Logistic regression analysis tested preoperative risk factors for postoperative complications.
RESULTS: Baseline prostate volume was (median, IQR) 87 (60, 120) ml. As a whole, in-hospital and after discharge complications were 19% and 11.6%, respectively, with a 28.6% overall rate at 12 months from surgery. Complications were graded as CD 1 [8% (22)], 2 [18.2% (52)] and 3 [1.8% (5)], respectively. Fever was the most frequently reported (11% of cases), followed by acute urinary retention (8%). At logistic regression analysis, older age (OR: 1.07; 95%CI: 1.01-1.12; p=0.01) and having an indwelling catheter before surgery (OR: 4.03; 95%CI 1.64-9.9; p=0.002) emerged as significant risk factors for post-HoLEP complications, after accounting for surgeon experience and baseline parameters.
CONCLUSIONS: HoLEP is a safe procedure in a high volume center with less than 2% high-grade complications. Older patients with indwelling catheter deserve to be carefully managed due to a higher risk of postoperative complications.

KEY WORDS: HoLEP; Complications; LUTS

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