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 initial 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 2017–2021, 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.

Results: A total of 40 emergency HoLEP procedures were performed. Our cohort had a mean prostate volume of 120.2+47.5 cc and a mean resected weight of 88.7+42.2 g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications. Intraoperative parameters and perioperative outcomes revealed a mean drop in hemoglobin of 11+4% (Table 1). The urethral catheter was removed within one day in 95% of patients with a successful trial of voiding. Moreover, 92.5% of patients were discharged home within 24 hours of their procedure. Two patients (5%) experienced clot retention, with a 2.5% overall readmission rate.

Conclusions: Our initial experience demonstrates that emergency HoLEP may be an effective treatment for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.