Feasibility and Safety of Holmium Laser Enucleation of the Prostate for Small to Medium Volumes Under Local Anesthesia with the Schelin Catheter and Sedoanalgesia: Results from a Single-Center Pilot Study

INTRODUCTION: This study aimed to evaluate the feasibility and safety of patients undergoing holmium laser enucleation of prostate (HoLEP), under transurethral intraprostatic anesthesia (TUIA) using Schelin Catheter (SC) and sedoanalgesia. MATERIALS AND METHODS: We retrospectively analyzed data of patients affected by benign prostatic obstruction candidate to HoLEP under TUIA using SC, from November 2023 to May 2024. RESULTS: A total of 50 patients were enrolled, median age 67 years; 14% were ASA ≥ 3, 2% and 22% had anticoagulation and antiplatelet drug therapy; 60% received alpha blockers, and 22% had both alpha blockers and 5α-reductase inhibitors; and 18% with an indwelling catheter. Preoperative median International Prostate Symptom Score (IPSS) and IPSS-quality of life (IPSS-QoL) were 16 (IQR: 11-21) and 4 (IQR: 4-6), median Qmax 10 mL/sec (IQR 3-19), median postvoid residual (PVR) 79 mL (IQR: 0-500). The median prostate volume was 50 mL (IQR 41-70 cc). Median preoperative Prostate Specific Antigen (PSA) was 1,70 (IQR 1,1-2,95). A prostate volume ≥ 80 mL was present in 10% of patients. The median enucleation time was 13,6 minutes (IQR 11,15-21,45) and the median morcellation time was 8,3 minutes (IQR 4,2-10,8). The median enucleated weight was 33 g (IQR 19,50-50). Median pain numeric rating scale before surgical procedure, at SC insertion, during enucleation, during morcellation, 2-hours postoperatively, on day 1 and 2 were 1 (0-3), 5 (2-6), 5 (3-7), 7 (5-10), 2 (1-4), 2 (1-4), and 3 (2-6). During enucleation, 10% required to start the target-controlled infusion with propofol. During morcellation, a half needs to get started propofol administration. The catheter was removed within 2 days in 100% of patients, and all were discharged within 48 hours. IPSS, IPSS-QoL, Qmax, and PVR showed significant improvement at 3 months. CONCLUSIONS: TUIA with sedoanalgesia in HoLEP of small/medium prostate volume offers good pain control, preserving the significant improvement of postoperative outcomes.