Factors affecting de novo urinary retention after Holmium laser enucleation of the prostate.
OBJECTIVE
Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP.


METHODS
336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups.


RESULTS
The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498-0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004-0.383) or a transfusion (OR 0.144, 95% CI 0.027-0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05).


CONCLUSIONS
De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.
Department of Urology, National Cancer Center, Goyang, Gyeonggi, South Korea.
Sung Han
SH
Kim
Departments of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America.
Changwon
C
Yoo
Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Minsoo
M
Choo
Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Jae-Seung
JS
Paick
Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Seung-June
SJ
Oh
D000367:Age Factors; D000368:Aged; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000473:pathology / Q000601:surgery; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000209:etiology / Q000517:prevention & control*