Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate

Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial. We now present an expanded update after widespread adoption at our facility. Methods: We reviewed patients who underwent same day catheter removal after HoLEP between January 1, 2020 and March 21, 2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. Results: The success rate of same day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 ± 8.6 years and prostate volume was 109.2 ± 61.5 cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with American Society of Anesthesiology score (ASA) 3 or 4 failed catheter removal compared with 3.9% of patients with ASA 1 or 2 (likelihood ratio 9.32, p = 0.002), ASA status lost significance on multivariate analysis (p = 0.076). Effective catheter removal was not significantly associated with age, body mass index, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, American Urologic Association symptom score, prior BPH surgery, or prostate cancer in final pathology report. Conclusion: Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.