Holmium laser enucleation of the prostate and strictures: long-term outcomes, stricture characteristics, and risk factors.

PURPOSE

Holmium laser enucleation of the prostate (HoLEP) is a well-established treatment for benign prostatic hyperplasia (BPH). However, long-term data on postoperative urethral strictures remain scarce. This study aimed to evaluate the incidence, anatomical characteristics, timing, and potential pre- and perioperative risk factors for stricture formation following HoLEP.

METHODS

A retrospective analysis was conducted on 1,724 patients who underwent HoLEP between September 2015 and October 2022. Patients with pre-existing urethral strictures were excluded. Data on demographics, surgical details, and postoperative outcomes were collected. Follow-up was achieved in 1,512 patients (87.7%) over a mean duration of 5.03 years. Urethral and bladder neck strictures requiring intervention were identified through clinical follow-up or structured telephone interviews. Risk factors were assessed using logistic regression.

RESULTS

Urethral strictures (US) were found in 5.0% of patients and bladder neck strictures (BNS) in 2.0%. Most US were located in the bulbar urethra (90.7%) and developed within two years postoperatively. Smaller prostate volume and lower PSA were significantly associated with increased stricture risk. BNS risk was additionally linked to shorter operative time, lower laser energy, and less surgeon experience. Strictures were predominantly short-segmented; 21.1% were longer than 2 cm.

CONCLUSION

Stricture formation after HoLEP, though infrequent, remains a relevant long-term complication. Identifying patients at higher risk based on prostate size, catheter use, and surgical parameters can help inform preventative strategies and improve postoperative counseling and outcomes.