HoLEP Safe and Effective for Elderly Patients with Indwelling Catheters, Study Shows
France: A recent retrospective dual-center study has shed light on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in elderly patients reliant on indwelling urinary catheters. The findings, published in the World Journal of Urology, provide valuable insights into the procedure’s outcomes, particularly in a demographic often presenting with complex medical needs.
"In patients over 85 years old with indwelling catheters, HoLEP enabled 97% to achieve spontaneous micturition, with a urinary incontinence rate of 11% at the one-year follow-up," the researchers reported. They found that the elderly group exhibited comparable complication rates, transfusion requirements, and postoperative outcomes to their younger counterparts. Additionally, the one-year mortality rate for the senior group was 14%, closely mirroring that of the general male population in the same age bracket.
Clément Klein, Urology Department, CHU Bordeaux, Bordeaux, France, and colleagues conducted the study to assess the safety and effectiveness of HoLEP in patients over 85 years old with indwelling catheters (IDC).
For this purpose, the researchers retrospectively analyzed a bicentric HoLEP database to identify consecutive patients with indwelling catheters (IDC) and trials without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. The primary focus was on patients over 85 years, with those under 70 serving as controls. The study evaluated postoperative spontaneous micturition rates, adverse events, mortality, catheterization duration, hospital stay, and urinary incontinence rates.
The following were the key findings of the study:
- A total of 144 patients were included, with 71 in the ≥ 85 group and 73 in the control group. The median prostatic volume in the ≥ 85 and control groups was 90 mL and 90 mL, respectively.
- The median Charlson score for the ≥ 85 and control groups was 6 and 3, respectively.
- Postoperative major complication rates were 2% in the ≥ 85 group and 3% in the control group, with no significant difference.
- Transfusion rates were 11% in the ≥ 85 group and 9% in the control group, with no significant difference.
- The median length of stay was significantly longer in the ≥ 85 group (2 days) compared to the control group (1 day)).
- The rate of trial without catheter (TWOC) failure during hospitalization was significantly higher in the ≥ 85 groups (24%) compared to the control group (5%).
- At the 3-month follow-up, 0 patients in both groups had died, whereas at the 1-year follow-up, 14.1% of patients in the ≥ 85 group and 3% in the control group had died.
- One year after surgery, 97% of patients in the ≥ 85 group and 100% of patients in the control group could void spontaneously.
The findings revealed that HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. One year post-surgery, 97% of patients regained the ability to void spontaneously, with a urinary incontinence rate of 11%. The one-year mortality rate was 14%, which is similar to the mortality rate observed in the general male population of the same age.
Reference:
Klein, C., Anract, J., Pinar, U. et al. Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study. World J Urol 43, 75 (2025). https://doi.org/10.1007/s00345-024-05437-9
