Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate

Purpose: We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). Methods: We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. Results: Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n = 299, 19.1%) or salvage (n = 58, 3.7%) therapy. Patients in the TUC group were older (mean ± standard deviation, 70.6 ± 7.3 years vs. 69.3 ± 7.0 years; P = 0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P < 0.001), higher serum prostate-specific antigen (PSA) (5.4 ± 4.8 ng/mL vs. 3.8 ± 4.5 ng/mL, P < 0.001), larger total prostate volume (TPV) (89.5 ± 44.7 mL vs. 66.0 ± 32.6 mL, P < 0.001), and larger transitional zone volume (TZV) (57.3 ± 34.9 mL vs. 37.7 ± 24.2 mL, P < 0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV < 22.3 mL, the OR was 2.42 in 34.1 mL ≤ TZV < 53.5 mL (95% confidence interval [CI], 1.58-3.72; P < 0.001), 5.17 in ≥ 53.5 mL (95% CI, 3.44-7.77; P < 0.001). Conclusions: The risk of TUC during HoLEP surgery increases in patients with TZV > 35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.