Impact of adjunctive bipolar coagulation during HoLEP on secondary postoperative bleeding: a bicentric retrospective study.

OBJECTIVE: To determine the impact of the use of bipolar coagulation during holmium laser enucleation of the prostate (HoLEP) on the risk of secondary hemorrhagic complications. METHODS: Retrospective bicentric study analyzing data from 501 patients who underwent HoLEP between 2017 and 2024. Patients were divided into two groups according to the type of intraoperative hemostasis: a laser-only hemostasis group and a group that received adjunctive bipolar hemostasis. The primary endpoint was the occurrence of clinically significant secondary hemorrhagic complications within 30 days after hospital discharge. A multivariable analysis was performed to determine factors associated with an increased risk of secondary bleeding. RESULTS: Patient demographic characteristics were comparable between the groups in terms of age, prostate volume, and antiplatelet therapy use; however, anticoagulant therapy was more frequent in the bipolar coagulation group (20.8% vs 12.8%, p=0.018). Thirty-six patients (7.2%) experienced secondary hemorrhagic complications, with no significant difference between the two groups (6.3% vs 8.6%, p = 0.316). Perioperative parameters, including hemoglobin variation and duration of irrigation, catheterization, and hospitalization, were also comparable between groups. In multivariable analysis, only anticoagulant therapy was associated with an increased risk of secondary bleeding (adjusted odds ratio 3.55, 95% CI 1.59-7.95; p = 0.002). CONCLUSION: Adjunctive bipolar coagulation during HoLEP is not associated with a higher risk of secondary bleeding, unlike anticoagulant therapy.