Introduction: Patients with neurological diseases (ND) are often excluded in the BPH literature due to higher rates of complications and worse peri-operative outcomes. In this study, we sought to compare HoLEP outcomes in patients with and without ND to determine if HoLEP reduced urinary tract infection (UTI) rates in the ND population. Methods: We collected a prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 and identified 118 patients with and 474 without ND. The following diseases were included: diabetes-related neuropathy (DM), Parkinson’s disease (PD), dementia (D), cerebrovascular accident (CVA), multiple sclerosis (MS), traumatic brain injury/hemorrhage (TBI), transient ischemic attack (TIA), brain/spinal tumors (BT), myasthenia gravis (MG), spinal cord injury (SCI), multiple systems atrophy (MSA), cerebral palsy (CP), and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p < 0.05). Results: A total of 118 patients were identified with 135 different neurological diseases: DM (30), PD (9), D (17), CVA (26), MS (2), TBI (8), TIA (16), BT (16), MG (4), other (7). ND patients were more likely to have indwelling catheters (61% vs 43%, p=0.01) and UTIs pre-operatively (32% vs 19%, p=0.002). Post-op, ND patients were more likely to fail initial trial of void (20% vs 8.1%, p<0.001) and experience acute urinary retention (16% vs 8.5%, p=0.024). Within 90 days post-op, complication rates were higher in the ND group (26% vs 13%, p=0.001). Within the ND group, 30/118 (25%) had =1 UTI within 90 days pre-op which decreased to 10/118 (8.7%) 90 days post-op (p < 0.001). At time of last follow-up (mean: 4.2 mos (ND) vs 3.95 mos (non-ND), p=0.4), 5 patients (5.6%) in the ND group utilized CIC/foley post-HoLEP compared to 0 in the non-ND group (p < 0.001)- 2 on CIC BID/1x per month but voiding otherwise and 3 requiring indwelling catheter (1 due to personal preference). IPSS scores and Michigan Incontinence Symptom Index (M-ISI) scores were similar amongst both groups. ND patients exhibited significant improvements in pre- vs post-op IPSS Scores (24.5 vs 7.8, p<0.001) and M-ISI bother scores (1.7 vs 1.1, p=0.04). Conclusions: Patients with neurological diseases undergoing HoLEP are more likely to experience post-op retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced 3-month UTI rates and catheterization rates. SOURCE OF Funding: none
