Holmium Laser Enucleation of the Prostate (HoLEP) is an effective surgical option for treating benign prostatic hyperplasia (BPH), suitable for prostates of any size. Although urinary tract infections (UTIs) occur in 3-20% of cases after HoLEP, soft tissue infections such as epididymitis and/or orchitis (EO) have not been thoroughly examined. By comparison, EO occurs in 1-2% of patients following transurethral resection of the prostate (TURP). Unlike TURP, HoLEP involves high-pressure irrigation near the surgical capsule, which may elevate the risk of EO. This study investigates the incidence and risk factors associated with both general infectious complications and specific soft tissue infections following HoLEP.
A cohort of 300 patients who underwent HoLEP at a tertiary center between June 2018 and January 2022 was randomly selected from a database maintained by five surgeons. Clinical data and post-surgical infectious complications were analyzed. UTI was identified based on urinary symptoms and a positive urine culture (>100,000 CFU of a pathogenic organism), while EO was confirmed by patient-reported pain and ultrasound findings.
Within 90 days post-surgery, 26 patients (8.7%) experienced infectious complications, including UTI (61.5%) and EO (38.5%). All EO cases with positive cultures were caused by gram-negative bacteria. While no significant differences in preoperative characteristics were found between patients with or without infections, a longer post-operative catheter duration (4.2 vs. 2.7 days) was linked to a higher rate of infections overall, though not specifically EO. The presence of preoperative bacteriuria, a history of recurrent UTI, or illness severity post-surgery did not correlate with the incidence of UTI or EO.
This study found a 3% incidence of soft tissue infections following HoLEP, suggesting that these patients may be at a greater risk for EO than those undergoing other BPH procedures. The findings support early catheter removal to minimize infection risks when possible.
