Outcomes of Holmium Laser Enucleation of the Prostate in Patients with Chronic Painless Urinary Retention and Postvoid Residual Urine ≥ 1‐l: A Critical Evaluation at the Extreme Ends of the Spectrum

Objectives Chronic painless urine retention (CUR) with > 1 liter of postvoid residual urine (PVR) is a rare but serious complication of benign prostatic obstruction (BPO). This study aims to evaluate the outcomes of HoLEP in men with chronic painless urinary retention and PVR volumes exceeding 1 l. Methods We retrospectively reviewed data from men who underwent “en‐bloc” HoLEP between July 2017 and May 2024. We identified patients with CUR and PVR > 1 l due to BPO (study group). Excluded were those with acute‐on‐chronic retention, bladder diverticulum or neurogenic bladder. A matched‐pair analysis (1:2) was performed with patients having PVR < 50 ml (control group). We compared demographic, perioperative, and postoperative voiding parameters and complications up to 1 year. Results Of 660 patients, 20 had baseline PVR > 1 l. Demographic and preoperative parameters were similar, except for a higher catheterization rate in the study group (50% vs. 17.5%, p < 0.005). The study group had a higher risk of failing a voiding trial on the first postoperative day (20% vs 5.2%) though the difference was not statistically significant. By 1‐month post‐HoLEP, all patients in the study group were catheter‐free and voiding spontaneously. No significant differences were found in postoperative voiding improvements and complications between the groups. Neither group required medical or surgical retreatment within 1 year. Conclusions HoLEP is effective and safe for patients with CUR and PVR > 1 l due to BPO, although these patients have a higher risk of failing a voiding trial on the first postoperative day.