Evaluation of Postoperative Urinary Tract Infection and Sepsis Rates After Adding Cystolitholapaxy to HoLEP: A Retrospective Analysis

Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH). In patients with concurrent bladder stones, cystolitholapaxy can be performed during the same procedure, but its impact on postoperative infections is unclear. We retrospectively analysed 278 patients who underwent HoLEP alone (n = 205) or HoLEP with cystolitholapaxy (n = 73) between 2017 and 2024. Baseline characteristics including age, prostate size, body mass index (BMI), diabetes mellitus (DM), and postoperative infectious outcomes were compared. Urinary tract infection (UTI) was defined by abnormal urinalysis within 30 days, and sepsis was defined clinically. Independent t-tests and Fisher’s exact test were used, with p < 0.05 considered significant. Baseline demographics were similar between groups (mean age: 73.46 vs. 73.41 years, p = 0.956; prostate size: 106.97 vs. 117.92 mL, p = 0.104; BMI: 27.64 vs. 28.50 kg/m², p = 0.281). The HoLEP + cystolitholapaxy group had more DM patients than HoLEP only (37.7% vs. 22.5%; Odds ratio (OR) = 2.08, 95% CI 1.16–3.74; p = 0.018). Postoperative UTI occurred in 22/205 (10.7%) HoLEP-only and 12/73 (16.4%) combined patients (OR = 0.85, 95% CI 0.43–1.64; p = 0.643). Sepsis was rare (1/205 in HoLEP-only; 0/73 in combined; OR = 0.93; p = 1.000). Despite higher DM prevalence in the HoLEP + cystolitholapaxy group, no significant differences in postoperative UTI or sepsis were observed. Combining HoLEP with cystolitholapaxy appears safe, allowing comprehensive management of BPH and bladder stones in a single session without increasing infectious risk.