One-Night Catheter Stay after Holmium Laser Enucleation of the Prostate: A Single-Center Comparative Study

Holmium laser enucleation of the prostate (HoLEP) is a well-established treatment for benign prostatic hyperplasia (BPH), known for its safety and efficacy across all prostate sizes. However, one persistent area of variability in post-HoLEP care remains: how long should a catheter stay in?

In our study, we challenged the common practice of leaving the catheter in place for two or more days by exploring the safety and effectiveness of early (one-day) catheter removal. By retrospectively analyzing outcomes from 258 HoLEP procedures at our center, we compared two patient groups—those with catheter removal on postoperative day one vs. day two or later.

The results were both clear and compelling:

Patients with early catheter removal had significantly fewer re-catheterizations (1.5% vs. 21.9%) and
Shorter hospital stays (median 1 vs. 2 days).

Interestingly, catheterization duration itself emerged as the only independent predictor of re-catheterization. Contrary to some previous studies, neither prostate size, enucleation time, nor preoperative residual volume were significant predictors in our models. Notably, over half of re-catheterizations were infection-driven, reinforcing the idea that prolonged catheterization may actually increase—rather than reduce—the risk of complications.

Our findings support a paradigm shift in postoperative HoLEP management: early catheter removal is not only feasible but may actively improve recovery and reduce complications, particularly infections. While additional research—especially prospective, multicenter trials—is warranted, our data advocate for streamlined protocols that enhance patient comfort without compromising safety.

In an era of minimally invasive surgery, it’s time we apply the same principle to postoperative care. Earlier is better—and safer—when it comes to catheter removal after HoLEP.

Figure. Cumulative incidence hazard curves for re-catheterization in Group A (catheterization duration: >1 day, blue line) vs. Group B (catheterization duration: ≤1 day, red line). The red line for Group B was not depicted due to the paucity of re-catheterization events.

Written by: Riccardo Giuseppe Bertolo, M.D, Ph.D, Ricercatore Universitario, UOC Urologia, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italia

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