Analysis of Risk Factors for Formation of Bladder Neck Contracture After Holmium Enucleation of Prostate

PURPOSE: Holmium laser enucleation of prostate (HoLEP) offers a size independent approach to the treatment of benign prostatic hyperplasia (BPH). Bladder neck contracture (BNC) is a known complication after HoLEP. This study evaluates the incidence and risk factors associated with the formation of BNC after HoLEP. METHODS: A retrospective review was conducted from 2020 to 2022 of men undergoing HoLEP by a single surgeon. Pre- and perioperative factors were compared including catheter dependence, previous and concurrent procedures, laser type, enucleated gland weight, and energy usage. RESULTS: A total of 185 men were identified for the study. An incidence of BNC occurred in 9.2% of patients (n = 17). On univariate analysis, enucleated gland weight was significantly associated with BNC (72.2 vs 34.5, p = 0.007).  Of men with enucleated weight less than 18gm, 8 (23.7%) had BNCs vs 8 men (5.7%) with enucleated weight > 18 gm (p = <0.001). The presence of bladder stones at time of HoLEP was significantly associated with formation of BNC, as 17.6% of men with BNCs had bladder stones (p = 0.039). Prior urethral dilation was significantly associated with BNC (11.8%, p = 0.023). Mean time to diagnosis of BNC was 6.5 months. Mean follow up was 17.9 months. CONCLUSIONS: Our study identified smaller glands, as well as concurrent bladder stones and previous stricture disease, as significant risk factors for the development of BNC after HoLEP.  This study underscores the importance of preoperative anatomical evaluation in patient counseling and discussion of individual risk factors.