The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications.
All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed®, Scopus®, and Web of Science™ databases from January 1, 1998, to June 1, 2020.
Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0-7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%).
HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1-2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique.
Urologia internationalis. 2021 Sep 21 [Epub ahead of print]
Angelo Porreca, Michele Colicchia, Alessandro Tafuri, Daniele D'Agostino, Gian Maria Busetto, Alessandro Crestani, Katia Odorizzi, Nelia Amigoni, Riccardo Rizzetto, Alessandra Gozzo, Sebastian Gallina, Lorenzo Bianchi, Matteo Ferro, Roberto Falabella, Daniele Romagnoli, Alessandro Antonelli, Paolo Corsi, Riccardo Schiavina
Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy., Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Abano Terme, Italy., Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy., Department of Urology, Sapienza Rome University Policlinico Umberto I, Rome, Italy., Department of Urology, University of Bologna, Bologna, Italy., Division of Urology, European Institute of Oncology (IEO), Milan, Italy., Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy.