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Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience

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Abstract

Introduction

Refractory hematuria secondary to prostatic disease typically resolves with conservative management; however, this condition may require hospitalization with extensive measures to control life-threatening bleeding. The aim of this study was to report our experience using holmium laser enucleation of the prostate (HoLEP) as an emergency treatment in this clinical setting.

Methods

We conducted a retrospective review of all patients that presented to the emergency department with refractory hematuria of prostatic origin from October 2017 to September 2021, for whom hospitalization and conservative management failed to control bleeding. All emergency HoLEP procedures were performed by a single surgeon. Preoperative and intraoperative parameters, as well as perioperative outcomes, were collected and analyzed. Postoperative outcomes included duration of foley catheterization, length of postoperative hospital stay, and hospital readmissions.

Results

A total of 40 emergency HoLEP procedures were performed. Our cohort had a median prostate volume of 110.5 cc and a median resected weight of 81 g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications on admission. The urethral catheter was removed within 1 day in 95% of patients with a successful trial of void (TOV). Moreover, 92.5% of patients were discharged home within 24 h of their procedure. Two patients (5%) experienced clot retention within one-week post-discharge with a 2.5% overall readmission rate. All postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual volume (PVR), showed significant improvement at 1 year follow up.

Conclusion

Our experience demonstrates that emergency HoLEP is an effective treatment option for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.

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Data availability

The data that support the findings of this study are available from the corresponding author, Hazem Elmansy, upon reasonable request.

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Authors and Affiliations

  1. Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada

    Hazem Elmansy, Amr Hodhod, Moustafa Fathy, Ahmed Elshafei, Ahmed S. Zakaria, Ryan Kelly, Loay Abbas, Ruba Abdul Hadi, Ahmed Kotb & Walid Shahrour

  2. Urology Department, Menoufia University, Shebin Elkom, Egypt

    Moustafa Fathy

  3. Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Philippe D. Violette

  4. Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada

    Radu Rozenberg & Amer Alaref

Authors
  1. Hazem Elmansy
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Contributions

HE: Protocol/project development and manuscript editing. AH: Stastical analysis and manuscript editing. MF: Data collection and management. PV: Manuscript editing. AE: Stastical analysis and manuscript writing. AZ: Protocol/project development and manuscript writing. RK: Manuscript writing. RR: Manuscript writing. AA: Manuscript writing. LA: Data collection and manuscript writing. RAH: Manuscript editing. AK: Manuscript editing. WS: Manuscript editing.

Corresponding author

Correspondence to Hazem Elmansy.

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No conflict of interest.

Research involving human participants and/or animals

The study was approved by our institutional research ethics committee (Northern Ontario School of Medicine) and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The study has a retrospective nature where data are already available and no patients contact or further interviews are required.

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Elmansy, H., Hodhod, A., Fathy, M. et al. Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience. World J Urol 41, 805–811 (2023). https://doi.org/10.1007/s00345-023-04292-4

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