Evaluation of Renal Function Recovery Following Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease

Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function following HoLEP remains unknown. We sought to describe changes in renal function following HoLEP in men with CKD. Methods: A retrospective study was conducted of patients who underwent HoLEP with GFRs <60, CKD stage III-V. Preoperative and postoperative GFR were selected within three months prior of the operation and within 1 year of postoperatively. The presence of an indwelling catheter, preoperative hydronephrosis, history of kidney stones and prostate size were also reviewed. Data was analyzed in accordance with preoperative CKD stage. Results: Of the reviewed patients, 138 met inclusion criteria with CKD stages III-V. Each CKD group was without significant postoperative complications. There was a significant increase between preoperative and postoperative GFR for patients in CKD stages III (n=116) and IV (n=17) (p<0.0001 and p=0.010, respectively). The mean increase between pre- and postoperative GFR for the CKD stage III and IV patients were 6.4 and 6.49, respectively. There was no correlation between presence of preoperative hydronephrosis, history of kidney stones, catheter dependency, nor prostate size on change in postoperative GFR (p>0.05). Conclusion: These findings suggest that patients in CKD stages III or IV undergoing HoLEP experience an increase in GFR. It is noteworthy that there appears to be no decline in renal function postoperatively in any group. HoLEP represents an excellent surgical option for patients with pre-operative CKD and may prevent further renal decline.