Perioperative anesthetic management characteristics associated with early postoperative voiding recovery and short-term urinary outcomes after HoLEP in elderly frail patients: a retrospective study.

OBJECTIVE: To identify anesthetic factors associated with early voiding recovery after holmium laser enucleation of the prostate (HoLEP) in elderly frail patients, and to compare short-term urinary outcomes by recovery status. METHODS: This single-center retrospective study included frail patients (aged ≥75 years, Clinical Frailty Scale score ≥5) who underwent HoLEP between January 2021 and December 2024. Patients were classified into good recovery, defined as spontaneous voiding after first catheter removal, and poor recovery defined as the inability to void or the need for re-catheterization. Baseline characteristics, perioperative variables, short-term outcomes were compared. Stepwise logistic regression was used to identify factors associated with early voiding recovery. Multivariable logistic regression was used to assess the association between recovery status and a composite adverse outcome including postoperative incontinence, urinary tract infection, hematuria or clot retention, and 30-day readmission. RESULTS: Among 194 frail patients, 136 (70.1%) had poor early voiding recovery. In multivariable analysis, poor recovery was independently associated with higher postvoid residual volume (PVR, P<0.001), intraoperative hypotension (OR 27.483, P<0.001), greater intraoperative fluid administration (per 100-mL increase: OR 1.627, P<0.001), and general anesthesia (OR 3.231, P=0.023). Patients with poor recovery had longer catheterization duration, longer hospital stay, and higher rates of incontinence, urinary tract infection, and readmission (all P<0.05). Poor recovery was independently associated with the composite adverse outcome (adjusted OR 4.301, P<0.001). CONCLUSION: Early voiding status after catheter removal serves as a simple and practical clinical indicator to identify elderly frail HoLEP patients at risk of adverse short-term urinary outcomes.