Urethral Complications While Using 26F vs 28F Resectoscope Sheaths in Holmium Laser Enucleation of the Prostate: A Retrospective Observational Study

To determine the rate of the urethral stricture (US) and bladder neck contracture (BNC) between patients who undergo Holmium Laser Enucleation of Prostate (HoLEP) surgery with 26F 28F resectoscope sheaths (RS). Studies report rates of 2.8-4.4% and 3.6-5.4% for US and BNC, respectively. To date, there are no studies that have shown the difference between RS size and urethral complications. We retrospectively reviewed charts of patients who had HoLEP surgery between August 2015 and June 2018, by a single surgeon. Those with a prior history of US or BNC were excluded. The operative set-up for an HoLEP includes Ho:YAG laser, urethral dilation, a 26F or 28F continuous flow RS, and a tissue morcellator. Primary endpoints include postoperative US or BNC. Secondary endpoints include postoperative catheterization time, success of voiding trial, and urinary incontinence. Statistical analysis was performed by using appropriate methods. Out of 502 HoLEP patients, 339 consecutive patients had surgery with a 28F RS (Group A) and 163 consecutive patients had surgery with a 26F RS (Group B). Twelve patients (A) and three patients (B) had post-op US ( = 0.41). Eight (A) and zero (B) patients had post-op BNC ( = 0.0585). Stress urinary incontinence at 6 weeks, 3-6 months, and 1 year was present in 15.9% (both A & B), 6.5% (A) 6.1% (B) ( = 0.88), and 3.2% (A) 1.8% (B) ( = 0.564), respectively. Both blood loss and change in hemoglobin were higher in the 28F group with no significant difference in rate of transfusion. RS size had no impact on the rate of US or BNC; however, there was lower incidence in the 26F sheath cohort for both. The 28F sheath had a larger change in hemoglobin levels and estimated blood loss, but the higher rate of transfusion was not statistically significant. There was no difference in the stress incontinence rates, length of stay, and enucleation rates.