Introduction: There is a paucity of literature examining lower urinary tract symptoms (LUTS) and urinary tract infection (UTI) rates in patients with neurological disease states undergoing holmium laser enucleation of the prostate (HoLEP). We describe our experience in these patients at a high-volume center. Our primary objective was to determine if HoLEP affected UTI rates. 

Methods: We prospectively enrolled 50 patients with neurological diseases: (Parkinson’s [PD], myasthenia gravis [MG], cerebrovascular accident [CVA], transient ischemic attack [TIA], traumatic brain injury [TBI], dementia [D], brain/spine tumors [BT], diabetes with neuropathy neurogenic bladder [DM], and other) undergoing HoLEP from March to September 2021 into our clinical registry. Continuous variables were expressed as mean (range) with heteroscedastic two-tailed t-test and Chi-squared (p<0.05).

Results: Fifty patients were included: CVA: 13, DM: 11, D: 7, TIA: 5, PD; 4, MG: 3, BT: 3, TBI: 2, other: 2. The average preop prostate size was 128 mL (range 23–400), intraoperative specimen weight 77 g (5–206), and body mass index 27 (19–40). Preoperative retention was present in 35/50 (70%) with an average preoperative catheter duration of 83 days (range 7–456). Within the three months preoperatively, 28/50 (56%) had ≥1 urinary tract infection (UTI), which decreased to 6/50 (12%) post-HoLEP (p<0.001). The average preoperative UTI rate was 0.86/3 months (0–5), which was reduced to 0.12/3 months (0–1) (p<0.001). Same-day catheter removal occurred in 30/50 (60%), with 4/30 (13%) failing. There were 12/50 (24%) postoperative emergency department visits with seven admitted (five non-urological etiology). Only 3/50 (6%) patients used catheters/clean intermittent catheterization at three months (p<0.001). Urinary incontinence in any form remained in 17/50 (34%) at three months. Overall, 90-day complication rate was 34% (I: 6, II: 6, IIIa: 3, IIIb: 1, IVa: 1, IVb: 0, V: 0). 

Conclusions: In this complex heterogenous cohort, HoLEP reduced indwelling catheter and three-month UTI rates with a 4% Clavien-Dino ≥IIIb complication rate. However, urinary incontinence rates and inability to void at three months were higher than historically observed in patients without neurological diseases.