Outcomes of Holmium Laser Enucleation of the Prostate in Patients with Chronic Painless Urinary Retention and Postvoid Residual Urine ≥ 1‐l: A Critical Evaluation at the Extreme Ends of the Spectrum

OBJECTIVES: Chronic painless urine retention (CUR) with > 1 liter of postvoid residual urine (PVR) is a rare but serious complication of benign prostatic obstruction (BPO). This study aims to evaluate the outcomes of HoLEP in men with chronic painless urinary retention and PVR volumes exceeding 1 l. METHODS: We retrospectively reviewed data from men who underwent "en-bloc" HoLEP between July 2017 and May 2024. We identified patients with CUR and PVR > 1 l due to BPO (study group). Excluded were those with acute-on-chronic retention, bladder diverticulum or neurogenic bladder. A matched-pair analysis (1:2) was performed with patients having PVR < 50 ml (control group). We compared demographic, perioperative, and postoperative voiding parameters and complications up to 1 year. RESULTS: Of 660 patients, 20 had baseline PVR > 1 l. Demographic and preoperative parameters were similar, except for a higher catheterization rate in the study group (50% vs. 17.5%, p < 0.005). The study group had a higher risk of failing a voiding trial on the first postoperative day (20% vs 5.2%) though the difference was not statistically significant. By 1-month post-HoLEP, all patients in the study group were catheter-free and voiding spontaneously. No significant differences were found in postoperative voiding improvements and complications between the groups. Neither group required medical or surgical retreatment within 1 year. CONCLUSIONS: HoLEP is effective and safe for patients with CUR and PVR > 1 l due to BPO, although these patients have a higher risk of failing a voiding trial on the first postoperative day.