235 - Impact of Sheath Size on HoLEP Outcomes: A Comparative Study Between 22F and 26F Sheaths

Objectives To compare functional outcomes and complications of HoLEP using 22–26 F sheath. Patients and Methods This retrospective analysis included data from patients who underwent HoLEP between May 2023 and September 2024. Patients were divided into two groups: Group 1 (22 F sheath) and Group 2 (26 F sheath). Functional outcomes assessed included International Prostate Symptom Score (IPSS), maximum flow rates (Q-max), and postvoid residual (PVR). Assessed complications were incidence of stress and urge incontinence, and urethral stricture. Follow-up was done at 1, 3, 6, and 12 months. Results A total of 190 patients were included (94 in Group 1 and 96 in Group 2). Intraoperative complications (two patients in group 2) and re-admission rates (one patient for each group for clot retention) were comparable. No major complications were reported. Group 1 demonstrated significantly lower IPSS scores at all follow-up intervals. Starting from third month follow-up, Q-max was significantly better for group 2. PVR was significantly better in group 2 in all follow-up intervals. Transient stress urinary incontinence rates were lower in group 1 at one and three months ( P < 0.001 and 0.045 respectively). Then both groups had comparable results. Urge urinary incontinence rates were lower in group 1 at one month ( P = 0.001), then they became comparable. Urethral stricture rates were 3.2% for 22 F group versus 6.2% for 26 F group, P = 0.321. In multivariate analysis, Sheath size was the only independent predictor of overall complications where odds ratio for 26 F sheath was 3.123, 95%CI: 1.15–8.48, P = 0.025). Conclusions The use of 22 F sheath in HoLEP showed improving IPSS and better early continence. The use of 26 F sheath resulted in better urine flow but was associated with more overall complications.