Holmium Laser Research Articles

Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study.

This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022-June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day -1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5-393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted.

The Effect of High- and Low-power Holmium Laser Settings for Transurethral Lithotripsy in the Management of Adults with Ureteral Stone.

Since there is insufficient evidence to determine the best treatment of transurethral laser lithotripsy (TLL) in ureteral stones, this study compared the effectiveness and safety of TLL using high-power (HP) (100 W) and low-power (LP) (20 W) laser settings. All patients with maximally sized ureteral stones who were planned for transurethral holmium laser lithotripsy were enrolled in this open study. One of the two laser setting groups-LP or HP-was allocated to each alternate patient. Using IBM SPSS Statistics 24, the treatment groups were compared for operating time, intraoperative and postoperative problems (up to 1 year), and rates of stone-free recovery. Welch tests were employed to compare continuous data, whereas Fisher's exact or Chi-square tests were used to assess categorical variables. At P < 0.05, statistical significance was established. A total of 207 individuals were included and preoperative data were comparable between the two groups. The HP group had a considerably greater ablation rate and a significantly shorter procedure duration (42.61 ± 11.74 min) than the LP group (78.56 ± 25.91 min) ( P = 0.025). The Overactive Bladder Symptom Score and International Prostate Symptom Score were considerably higher in the HP group than in the LP group. Treatment effectiveness was considerably impacted by the location of the ureteral stone, according to univariate and multivariate logistic regression models. A HP laser setting of up to 100 W greatly shortens the duration of the process for treating ureteral stones without raising the risk of problems.

Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Background: Urethral strictures and benign prostatic hyperplasia (BPH) are 2 common causes of urinary obstruction and urinary emptying symptoms. While urethroplasty and endoscopic management of BPH have been extensively discussed in the literature when performed on their own, a case of simultaneous urethroplasty and endoscopic management of BPH has not been previously described in the literature. Case Description: We present the case of a 75-year-old man with significant BPH and concomitant bulbar obliterative urethral stricture. After discussion of treatment options with the patient, we elected to perform both holmium LASER enucleation of the prostate (HoLEP) of a 200cc prostate and buccal graft urethroplasty during the same surgery. The HoLEP was performed through a dorsal urethrotomy in anticipation of urethroplasty. Nontransecting anastomotic repair was then combined with the buccal graft urethroplasty. The patient did not have any acute postoperative complications and had no recurrence. He reported improvements in outcome questionnaire scores and uroflow parameters at the 12-month follow-up. Conclusions: This case presentation is the first to report on simultaneous complex urethroplasty and endoscopic management of BPH, specifically HoLEP. It shows that this approach can lead to positive urinary outcomes without added complications and with lasting outcomes, thereby allowing the use of a combined surgical approach.

MP20-12 Day-case Holmium LASER Enucleation of the prostate (HoLEP): success rate and predictive factors of D0 discharge after 10 years of clinical experience

MP20-12 Day-case Holmium LASER Enucleation of the prostate (HoLEP): success rate and predictive factors of D0 discharge after 10 years of clinical experience

Application Analysis of Low-Pressure Perfusion Combined with Occluder in Holmium Laser Lithotripsy for Patients with Middle and Upper Ureteral Calculi.

Ureteroscopic holmium laser lithotripsy has become one of the main methods of treating ureteral calculi. However, in the treatment of middle and upper ureteral calculi, ureteroscopy is difficult to operate owing to the high location of calculi. Thus, how to improve the treatment effect and reduce the stone migration has become the focus in clinical settings. On this basis, we evaluated the application effect of low-pressure perfusion combined with occluder in holmium laser lithotripsy for patients with middle and upper ureteral calculi. This retrospective study selected 107 patients with middle and upper ureteral calculi who underwent low-pressure perfusion combined with ureteroscopic holmium laser lithotripsy from January 2021 to December 2022. We excluded 7 patients who did not meet the criteria, and ultimately included 100 patients. According to whether the occluder was used during the surgery, 100 patients were divided into groups A (n = 52, occluder) and B (n = 48, without occluder). The stone-migration rate during surgery, stone-clearance rate at 3 months after surgery, perioperative indicators, postoperative complication rate, and postoperative quality of life between the two groups were compared. The stone-migration rate in group A was significantly lower than that in group B, with statistically significant difference (p < 0.05). Both groups had no significant difference in stone-clearance rate at 3 months after surgery (p > 0.05). Group A had a significantly lower index of EuroQol (EQ) Five Dimensions Questionnaire and significantly higher score of EQ-Visual Analogue Scale than group B (all p < 0.001). Compared with the simple application of low-pressure perfusion, the combined application of low-pressure perfusion and occluder in ureteroscopic holmium laser lithotripsy can effectively reduce the stone migration and improve the postoperative quality of life.

Robotic Bladder Diverticulectomy with Concomitant Holmium Laser Enucleation of the Prostate

Robotic Bladder Diverticulectomy with Concomitant Holmium Laser Enucleation of the Prostate

P38 Impact of oral citrate treatment on residual renal microlithiasis following flexible ureteroscopy and Holmium laser lithotripsy

P38 Impact of oral citrate treatment on residual renal microlithiasis following flexible ureteroscopy and Holmium laser lithotripsy

MP20-17 Preoperative Continence and Holmium Laser Enucleation of Prostate Symptom (HoLEP) Recovery: A Close Look Into Patient Reported Outcomes

MP20-17 Preoperative Continence and Holmium Laser Enucleation of Prostate Symptom (HoLEP) Recovery: A Close Look Into Patient Reported Outcomes

MP20-13 Predictors of Post-Operative Incontinence after Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in their Experience

MP20-13 Predictors of Post-Operative Incontinence after Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in their Experience

MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis

MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis

The severity of lower urinary tract symptoms during the postoperative period as a factor in choosing an approach to surgical treatment for large prostate hyperplasia: holmium enucleation of the prostate (HoLEP) vs laparoscopic simple prostatectomy

Introduction. Analysis of complications after transurethral surgery for benign prostate hyperplasia (BPH) demonstrates that 20 – 30% of patients require prolonged postoperative treatment for severe lower urinary tract symptoms (LUTS) despite improvements in technology and surgical techniques. These complications play a significant role in reducing the quality of life of patients in the postoperative period. Severe storage symptoms and urgent urinary incontinence represent significant challenges in the postoperative phase when performing laser enucleation surgery. There are also limits to standard approaches to perform laparoscopic prostatectomy, which requires the development of improved techniques.Objective. To conduct a comparative assessment of the postoperative dynamics of LUTS in groups undergoing holmium laser enucleation of the prostate (HoLEP), a standard Millin laparoscopic simple prostatectomy (LSP), and a modified LSP.Materials &amp; Methods. This multicenter study included 439 patients who were randomly assigned to 3 groups depending on the surgical treatment technique used for bladder outlet obstruction associated with large-volume BPH: the HoLEP group (n = 151), the standard Millin LSP (n = 142) and the modified LSP, combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis (n = 146). The main criterion assessed during six-months follow-up was the severity of LUTS on the IPSS scale (obstructive and irritative components). Complications that developed during the postoperative observation period were recorded.Results. A lower severity of LUTS was revealed in the group of the modified LSP compared to the standard LSP and HoLEP (p = 0.041 and p = 0.001, respectively). The average irritative component of IPSS was significantly lower in the modified LSP group compared to the standard LSP and HoLEP (p = 0.032 and p = 0.001, respectively). The observed trend continued to the third month after surgery. Comparison of changes in symptom severity six months after surgery demonstrated a significant advantage for the modified LSP both compared to HoLEP (p = 0.017) and a standard LSP (p = 0.032). All three groups showed comparable significant improvements in quality of life.Conclusion. The severity of postoperative storage symptoms is a limitation of HoLEP use, whereas the standard LSP is associated with lower severity of LUTS. The authors' modification of the LSP has the potential to reduce the severity of storage symptoms in patients for up to three months after surgery, and is associated with a low rate of urge incontinence.

Holmium laser enucleation for large prostate hyperplasia: assessment of functional outcomes and postoperative complications

Introduction. To date, there has been insufficient research into the prostate volume as a factor that may influence the effectiveness and safety of surgical treatments. With the advent of relatively new laser techniques, it is important to take a closer look at this parameter, especially considering the success of these techniques in the treatment of benign prostatic hyperplasia (BPH) of various volumes.Objective. To assess the functional outcomes and postoperative complications of holmium laser enucleation of the prostate (HoLEP) depending on its volume.Materials &amp; Methods. We performed a prospective study of HoLEP on 252 patients. Patients were divided into two groups according to their prostate volume: Group I included 206 patients (81%) with a prostate volume of &lt; 100 mL, and Group II included 46 patients (19%) with a prostate volume ≥ 100 mL.Results. The prostate volume was the most significant prognostic factor regarding duration of surgery. This indicator significantly differed between the two groups. Group I had an average surgery time of 67.1 ± 26.7 minutes, while Group II had a time of 98.1 ± 24.2 minutes (p &lt; 0.05). There were no significant differences in the number of complications between the groups — 36 cases (17.5%) in Group I and 12 cases (26%) in Group II, as well as functional results of urination between the groups. In the early postoperative period, the Q max in Group I was 17.4 ± 9.1 ml/s, in Group II — 18.2 ± 10.9 ml/s (p &gt; 0.05), PVR — 52 ± 39.4 and 56 ± 31.8 ml (p &gt; 0.05), respectively. After 3 months of observation, there were also no differences in the studied parameters: IPSS — 5.7 ± 4.1 vs 6.2 ± 4.9 points; QoL — 1.0 ± 0.9 vs 1.1 ± 0.9 points; Q max — 18.9 ± 6.7 vs 20.3 ± 11.5 ml/s; PVR — 53.5 ± 33.1 vs 54.9 ± 30.6 ml (p &gt; 0.05).Conclusion. HoLEP is an effective and safe method of treating patients with different volumes of BPH. However, the duration of the procedure is an important factor that influences the surgery outcome, as it correlates with the prostate volume.

Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review.

Geriatric patients, prone to adverse events (AEs) and low compliance with drugs, may benefit from minimally invasive surgical therapies (MISTs) for managing benign prostatic hyperplasia (BPH). We evaluated the efficacy, safety, and procedural characteristics of MISTs in geriatric patients with BPH. PubMed/MEDLINE database was systematically searched for relevant articles through October 1, 2023. Eligible studies focused on geriatric patients (≥65 years) with BPH who were treated with MISTs and evaluated follow-up surgical, micturition, and/or sexual outcomes. Studies were included if there was separate reporting for age subgroups ≥65 years, or if the mean age minus standard deviation was ≥65 years, or if the first quartile was ≥65 years. Out of 292 screened studies, 32 (N = 3972 patients) met inclusion criteria and assessed prostatic artery embolization (PAE), Rezum, GreenLight, holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), diode laser enucleation of the prostate (DiLEP), and Aquablation. Except for Rezum, all MISTs required a planned overnight stay. While PAE and Rezum could be performed under local anesthesia, the other MISTs needed general or spinal anesthesia. Postoperative catheterization duration was longest for PAE (median 14 days) and Rezum (21 days) and shortest for GreenLight (1.9 days). At 12 months postoperatively, all MISTs exhibited significant percent changes in International Prostate Symptom Score (median -69.9%) and quality of life (median -72.5%). Clavien-Dindo Grade 1 AEs ranged widely, with PAE (5.8%-36.8%), Rezum (0%-62.1%), and GreenLight (0%-67.6%) having the largest range, and HoLEP (0%-9.5%), ThuLEP (2%-6.9%), and DiLEP (5%-17.5%) having the smallest. PAE, Rezum, DiLEP, and Aquablation reported no significant changes in the International Index of Erectile Function. Although all the MISTs reviewed in this study effectively treat BPH in geriatric patients, differences in procedural characteristics and safety profiles across MISTs were considerable. Physicians should use shared decision-making processes, considering risks and patient characteristics, when choosing a suitable treatment option for their patients.

The Effect of Laser Settings and Ureteral Access Sheath Size on Intrapelvic Temperature during Holmium Laser Lithotripsy

Introduction: Thermal damage to the kidney during holmium laser lithotripsy is a serious complication, which cannot always be prevented considering the diversity of conditions in the kidney and the lack of technical capability to measure intrarenal temperature in real-time. The aim of this study was to analyze the impact of different power settings of the holmium laser and the flow rate of irrigation fluid conditioned by the size of the sheath on the fluid temperature in a model of the pelvicalyceal system during lithotripsy. Materials and Methods: A lithotripsy of artificial stones was performed in a 3D-printed model of the renal pelvicalyceal system with a volume of 20.5 mL. A gravity-driven fluid flow was applied (p = 60 cm H2O). A 9.2Fr ureteroscope was introduced into the model through a ureteral access sheath of either 10/12Fr or 12/14Fr. Lithotripsy power ranged from 12 to 25 W. Temperature was measured using thermography. Results: For the 10/12Fr ureteral access sheath, the fluid flow rate was 2.7 mL/min, with the maximum temperature reached within 20 min ranging from 45 to 50 °C. For the 12/14Fr ureteral access sheath, the fluid flow rate was 9.8 mL/min, with the achieved temperature ranging from 35 to 45 °C. Laser power influenced the rate of temperature increase and the maximum temperature reached. During the first 5 min, the rate of temperature increase was solely dependent on laser power, not on the flow rate. Temperatures of 40 °C were only not exceeded with high flow rates (12/14Fr sheath) and power below 20 W. Conclusions: In a short period, the rate of temperature increase depends solely on laser power, not on the irrigation flow rate. During prolonged lithotripsy, the maximum temperature value depends on both parameters.

A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?

To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.

A meta-analysis comparing treatment of benign prostatic hyperplasia with holmium laser enucleation and photoselective greenlight vaporization

Abstract Background We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP). Methods Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels. Results Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45–6.16, p = 0.02, I 2 = 92%), 3 months (MD, 2.78, 95% CI, 0.53 to 5.02, p = 0.02, I 2 = 89%), 6 months (MD, 2.13, 95% CI, 1.11 to 3.15, p &lt; 0.0001, I 2 = 87%), and 12 months (MD, 3.98, 95% CI, 2.06 to 5.89, p &lt; 0.0001, I 2 = 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, p = 0.0005). Conclusions Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.

Thulium or holmium laser or both: where will the journey take us?

The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.

Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer.

While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes. While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients. Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.

Advances in HoLEP technology and technique – Current state of play

Background: Until recently, Holmium laser enucleation of the prostate (HoLEP) utilisation has been limited despite its perceived benefits over alternative surgical and minimally invasive benign prostatic hyperplasia (BPH) treatments. Objective: The purpose of this review is to highlight our experience with recent advances in laser and morcellator technologies that have made it easier for urologists to consistently offer HoLEP as a safe, efficient, and effective in an ambulatory (day surgery) setting. Methods: Our narrative review focused on contemporary studies published within the last five years. Conclusions: Technological advances coupled with increasing availability of training opportunities has and will continue to improve patients’ accessibility to the gold standard in BPH surgical treatment. Furthermore, we will describe refinements in laser enucleation techniques that have improved procedural efficiencies, rates of temporary post-operative urinary incontinence, and preservation of sexual function. The effects of technical modifications on functional and durability outcomes are to be seen in further prospective studies. Level of Evidence: Level 7 (Expert Opinion)

Comparison of outcomes in patients with and without neurologic diseases undergoing holmium laser enucleation of the prostate.

We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following ND s were included: diabetes-related neuropathy/neurogenic bladder, Parkinson's disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [non-ND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates.