Holmium Laser Enucleation of the Prostate (HoLEP) has become the preferred surgical approach in treating bladder outflow obstruction (BOO) secondary to high volume benign prostatic enlargement in the United Kingdom. This is despite the plethora of new interventions available. Due to the excellent haemostatic properties of Holmium laser and low complication rates, day case procedures are increasingly being performed. An analysis of current practice to determine safety and outcomes of short stay HoLEP was conducted.

A retrospective analysis of electronic patient records for patients undergoing HoLEP between December 2020-April 2024 at three high volume urology centres in the United Kingdom.

441 patients, mean age 72y (range = 53-89y), mean body mass Index (BMI) 27.3 (1 Standard Deviation (SD) = 4), mean PSA 7.63 ng/ml (SD = 7ng/ml) and mean prostate volume of 111cc (SD = 27ml) underwent HoLEP. 20.8% patients were anticoagulated. Indications included: lower urinary tract symptoms (LUTS) in 32.8%, urinary retention in 47.9%, and high-pressure chronic retention in 8.5%.
Operative details: Mean operating time 119 min (SD = 48 min), mean morcellation time 28 min (SD = 22min), mean tissue resection of 77g (SD = 52g), 10% patients had malignant histology.
Post-operative outcomes: Mean post-operative stay was 0.6 days (SD = 1 day), with 51% as day case procedures. Urinary tract infection occurred in 3.1%, bleeding requiring non-routine review in 6.8% and return to theatre in 0.9%, Mean post-op QMax was 19.6ml/s, mean QMax improvement 113%. 12% patients complained of incontinence at first follow-up (3-6 months, ≥1 pad/day). 1.8% developed urethral stricture and 1 (0.2%) patient complained of persistent de novo erectile dysfunction (ED). Statistical analysis demonstrated that anti-coagulation, larger prostate volumes (>120cc) and pre-operative catheterisation were not associated with greater risk of complications or worse outcomes.

Patient demographics, operating time, resection weight and outcomes are in line with other large volume retrospective series. Patients undergoing HoLEP have minimal post operative complications even when on anti-coagulation medications and with larger prostate volumes.

HoLEP is a highly effective surgical treatment for BOO in large prostates with a low side effect profile which can routinely be performed safely as a day case procedure. Overall complication rates were low. Incontinence rates at first follow up underpin the importance of commencing pelvic floor exercises pre-operatively