Complications of laser enucleation of the prostate: Results at two institutions

Abstract Objective Benign prostate hyperplasia (BPH) is a common disease with bothersome symptoms. Conventional transurethral resection of prostate is the gold standard surgical treatment. Recently, various laser enucleation techniques of the prostate for BPH have been adopted worldwide. We report perioperative and postoperative complications with the modified Clavien classification system at two institutions. Materials and methods We performed a retrospective analysis through chart review among patients who had undergone laser enucleation of the prostate for BPH in two tertiary referral centers between January, 2009 and December, 2012. The primary outcome was peri- and postoperative complications, whereas secondary outcome was duration of hospital stay and catheterization. The mean age of 271 patients was 72.1 years (range, 51–93 years). Their mean prostate volume was 62.8 mL (range, 22–270 mL). Fifty-seven (21%) patients had prostate volume > 80 mL. There were 101 patients and 169 patients in the diode and thulium groups, respectively. Results No patients had Grade 5 complications. There were Grade 4a complications in three (1.1%) patients, Grade 3a in 22 (8.1%) patients, Grade 2 in nine (3.3%) patients, and Grade 1 in 62 (22.9%) patients. The prostate volume > 80 mL was not significantly related to higher complication rate ( p  = 0.456). The average duration of hospital stay and catheterization were 3.05 ± 0.75 days and 2.25 ± 1.29 days. Four patients (1.5%) needed secondary resection for residual prostate tissue. The complication rate of acute urine retention (AUR; p  = 0.285), urethral stricture ( p  = 0.996), minor ( p  = 0.430), major ( p  = 0.371), or all complications ( p  = 0.105) was not statistically different between diode and thulium groups. Conclusion Laser enucleation of the prostate was a safe treatment with low significant complication rate, even for large-volume prostates. The complication rates between diode and thulium lasers were not significantly different. The reoperation rate of laser enucleation was very low but patients with extremely large prostate volume may have higher risk.