Emergency holmium laser enucleation of the prostate for management of refractory hematuria.

PURPOSE: To evaluate the safety and efficacy of emergency holmium laser enucleation of the prostate (HoLEP) for the management of refractory hematuria in the acute inpatient setting. METHODS: A retrospective review of patients who underwent emergency HoLEP in the inpatient setting between January 2021 and August 2024 was performed. All procedures were performed by a single surgeon. Clinical and operative variables including indication for surgery, intra-operative findings, operative time, enucleated prostate volume, hospital course, perioperative transfusion requirements, post-operative catheterization status, and complications were collected. Post-operative outcomes including voiding trial success and catheter status at follow-up were assessed. Descriptive statistics were used to summarize patient characteristics and perioperative outcomes. RESULTS: A total of 24 emergency HoLEPs were performed: all for refractory hematuria and one additionally for prostate abscess. During the same admission, five patients had previously undergone cystoscopic fulguration and evacuation procedures. Eight patients had prior transurethral resections of the prostate, two photoselective vaporization procedures, and one prostate artery embolization. The median operative time was 102 min, and the median enucleated prostate volume was 156 g. Eighteen (75%) of the patients passed their voiding trial on post-operative day 1, and all were catheter-free at three-month follow-up. Ten patients required blood transfusions, including eight preoperatively and seven postoperatively. No patients required additional procedures. CONCLUSION: From our cohort, emergency HoLEP appears to be a safe and effective treatment for refractory hematuria. Patients demonstrated high rates of early catheter removal and catheter-free voiding at follow-up, with no patients requiring additional procedures.