Holmium Laser Enucleation of the Prostate (HoLEP) is a well-established treatment for lower urinary tract symptoms due to benign prostatic obstruction (BPO) causing urinary retention and consequent bladder catheterization. In recent years, also because of the pandemic, an increasing number of patients are compelled to maintain an indwelling bladder catheter for long periods before receiving adequate treatment, thus having a possible detrimental effect on detrusor contractility. As recently shown by a systematic review and meta-analysis [1], surgical treatment for BPO may be beneficial also in patients with altered bladder contractility. The aim of the study was to evaluate micturition recovery after HoLEP in men with long-term (> 5 months) indwelling bladder catheter at short-term follow‐up.

This was a retrospective, single center, cohort study. We retrospectively collected data from patients who underwent HoLEP in a single center by a single experienced surgeon between January 2022 and July 2023. Men were then divided in two cohorts based on the presence of bladder catheter before surgery (group A) or not (group B). After 3 months we evaluated surgery outcomes (maximum flow rate (Qmax), post‐void residual (PVR) and International Prostate Symptom Score (IPSS) questionnaire). Differences among groups were analyzed with unpaired T-test and results were displayed in boxplots.

Patients in group A (indwelling catheter) were 20 and patients in group B were 30; their characteristics are shown in table 1. No difference in baseline data were observed, except for prostate volume and hospital stay which were slightly higher in group A. Patients in group A had an indwelling catheter for a mean of 13.7 months. After surgery, all patients obtained a valid micturition recovery in terms of non-significant PVR (< 50mL) and sufficient Qmax (> 12mL/s). There was no statistical difference regarding PVR (p = 0.845) and IPSS (p = 0.101) between the two groups, while Qmax values were lower in group A (p = 0.009), although sufficient for a valid micturition (Table 1).

Baseline prostate volume was, as expected, higher for patients with indwelling catheter, reflecting their higher probability of suffering from BPO complications. The collected data at 3 months follow-up regarding surgery outcomes showed that patients in both groups were able to successfully empty their bladder, with non significant PVR and without significant symptoms, although urinary flow was less valid for group A. Lower Qmax in this group of patients may be due to a transient detrusor hypocontractility.

This retrospective analysis suggests that HoLEP is an effective treatment for valid micturition recovery also for patients with long-term indwelling catheter, with comparable results in terms of PVR and IPSS score, thus confirming the possibility to also treat patients with sub-optimal bladder contractility, with good outcomes. Prospective validation is essential to confirm these results.

1.	Wroclawski ML, Takemura LS, Santos HOD, Heldwein FL, Gauhar V, Lim EJ, Law YXT, Teoh JY, Herrmann TRW, Castellani D. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis. Neurourol Urodyn. 2024 Jan;43(1):126-143. doi: 10.1002/nau.25336. Epub 2023 Nov 27. PMID: 38010924.