Association between lateral lobe enucleation time and urethral stricture after Holmium Laser Enucleation of the Prostate (HoLEP): a retrospective cohort study.
- 1Department of Urology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul, Turkey. [email protected].
- 2Department of Urology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul, Turkey.
Abstract
Background
To evaluate whether lateral lobe enucleation time is associated with postoperative urethral stricture after holmium laser enucleation of the prostate (HoLEP).Methods
We retrospectively reviewed 519 HoLEP procedures performed between January 2023 and January 2025. To minimize operator- and technique-related heterogeneity, we included only standardized trilobar HoLEP cases performed by a single high-volume surgeon (> 400 prior cases); procedures by other surgeons and/or non-trilobar approaches were excluded. Urethral stricture was defined as symptomatic urethral narrowing confirmed endoscopically. The prespecified exposure was total lateral lobe enucleation time (sum of both lateral lobes), modeled per 10-minute increase. Associations were evaluated using Firth bias-reduced logistic regression.Results
Among 168 eligible patients, 8 (4.8%) developed urethral stricture. Total lateral lobe enucleation time was longer in the stricture group (median 70.0 [IQR, 53.0-70.0] vs. 32.5 [IQR, 26.0-45.2] minutes; p = 0.017). Follow-up duration differed between groups (p = 0.002). In multivariable Firth regression adjusting for age (per 10 years), prostate volume (per 10 g), and preoperative urethral catheterization, lateral lobe enucleation time remained independently associated with stricture (adjusted OR, 1.78 per 10 min; 95% CI, 1.24-2.53; p = 0.002). Preoperative urethral catheterization was also associated (adjusted OR, 4.48; 95% CI, 1.03-19.50; p = 0.045).Conclusions
Longer total lateral lobe enucleation time is independently associated with urethral stricture after HoLEP and may be related to increased instrument angulation and mechanical stress at the urethral fulcrum.
Related
- Urethral Stricture with a Miniaturised (22 Fr) Versus Standard (26 Fr) Resectoscope Sheath During Thulium Fibre Laser Enucleation of the Prostate: A Prospective, Two-Centre Comparative Cohort Study
- Function-preserving plasma kinetic enucleation of the prostate with bladder neck and 12 o'clock urethral mucosal preservation for large-volume benign prostatic hyperplasia: a single-center retrospective case series.
- Feasibility and safety of an F16 small-caliber catheter-based, irrigation-free protocol in BPH patients undergoing green laser enucleation of the prostate: a single-center retrospective cohort study
- Early Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease: A Single-Center Experience
- Comparison of low-power long-pulse width and high-power short-pulse width holmium laser enucleation of the prostate for benign prostatic hyperplasia: a retrospective study
BibTeX
@article{kayalı2026association,
title = {{Association between lateral lobe enucleation time and urethral stricture after Holmium Laser Enucleation of the Prostate (HoLEP): a retrospective cohort study.}},
author = {Yunus Kayalı and Tahsin Batuhan Aydoğan},
journal = {BMC urology},
year = {2026},
month = aug,
doi = {10.1186/s12894-026-02286-z},
url = {https://europepmc.org/article/MED/42958233},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between lateral lobe enucleation time and urethral stricture after Holmium Laser Enucleation of the Prostate (HoLEP): a retrospective cohort study.
AU - Yunus Kayalı
AU - Tahsin Batuhan Aydoğan
PY - 2026
DA - 2026/08/03
JO - BMC urology
DO - 10.1186/s12894-026-02286-z
UR - https://europepmc.org/article/MED/42958233
AB - Background To evaluate whether lateral lobe enucleation time is associated with postoperative urethral stricture after holmium laser enucleation of the prostate (HoLEP).Methods We retrospectively reviewed 519 HoLEP procedures performed between January 2023 and January 2025. To minimize operator- and technique-related heterogeneity, we included only standardized trilobar HoLEP cases performed by a single high-volume surgeon (> 400 prior cases); procedures by other surgeons and/or non-trilobar approaches were excluded. Urethral stricture was defined as symptomatic urethral narrowing confirmed endoscopically. The prespecified exposure was total lateral lobe enucleation time (sum of both lateral lobes), modeled per 10-minute increase. Associations were evaluated using Firth bias-reduced logistic regression.Results Among 168 eligible patients, 8 (4.8%) developed urethral stricture. Total lateral lobe enucleation time was longer in the stricture group (median 70.0 [IQR, 53.0-70.0] vs. 32.5 [IQR, 26.0-45.2] minutes; p = 0.017). Follow-up duration differed between groups (p = 0.002). In multivariable Firth regression adjusting for age (per 10 years), prostate volume (per 10 g), and preoperative urethral catheterization, lateral lobe enucleation time remained independently associated with stricture (adjusted OR, 1.78 per 10 min; 95% CI, 1.24-2.53; p = 0.002). Preoperative urethral catheterization was also associated (adjusted OR, 4.48; 95% CI, 1.03-19.50; p = 0.045).Conclusions Longer total lateral lobe enucleation time is independently associated with urethral stricture after HoLEP and may be related to increased instrument angulation and mechanical stress at the urethral fulcrum.
SN - 1471-2490
ER -