Dysuria after endoscopic laser enucleation of the prostate: how common, how long, and which patients are at risk? A prospective cohort analysis.

PURPOSE: Postoperative dysuria after endoscopic laser enucleation of the prostate (EEP) is common, yet its true incidence, temporal profile, and determinants remain poorly defined. We aimed to characterize the incidence, severity, and predictors of moderate-to-severe dysuria up to 6 months after EEP.

METHODS

In this prospective cohort study, we analyzed 108 patients who underwent EEP using Holmium (standard or Moses®) or pulsed Thulium (RealPulse®) lasers. Dysuria was assessed weekly using a Likert scale and categorized as mild (1-2), moderate (3-7), and severe (8-10). Patients with moderate-to-severe dysuria (score ≥ 3) were grouped for subsequent analyses. Associations were evaluated using Spearman correlation and multivariable logistic regression.

RESULTS

Moderate-to-severe dysuria (score ≥ 3) was highly prevalent early after surgery, affecting 75.9% of patients at week 1 and 29.6% at week 4, but declined sharply thereafter (8.3% at 3 months and 0.9% at 6 months). Early dysuria was associated with younger age, diabetes, and clot retention. Between 1 and 3 months, dysuria showed weak associations, with operative and functional variables, including operative time, total energy, enucleation efficiency, bipolar energy use, prior prostate biopsy, and postoperative Qmax. On exploratory multivariate analysis, younger age independently predicted early dysuria (OR 0.90, 95% CI 0.84-0.97, p = 0.007), while prior prostate biopsy predicted dysuria between 1 and 3 months (OR 10.85, 95% CI 1.12-105.15, p = 0.040).

CONCLUSIONS

Postoperative dysuria after EEP is highly prevalent during the early postoperative period but follows a predominantly self-limited course, with near-complete resolution after 12 weeks. These findings provide a detailed characterization of symptom evolution over time and may help improve postoperative counseling and patient expectations regarding recovery. Exploratory analyses identified associations with younger age and prior prostate biopsy.