Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.

OBJECTIVE: To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. PATIENTS AND METHODS: We analysed the patients' demographic, peri-operative and follow-up data, and the complications during and after surgery.
RESULTS: HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re-catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%).
CONCLUSIONS: There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient.