The financial burden of prolonged urinary retention in patients awaiting holmium laser enucleation of the prostate in the Quebec healthcare system

A retrospective cohort study

Authors

  • Shreya Udupa Faculty of Medicine & Health Sciences, McGill University, Montreal, QC, Canada
  • Elie Fadel Faculty of Medicine & Health Sciences, McGill University, Montreal, QC, Canada
  • Iman Sadri Division of Urology, McGill University Health Centre, Montreal, QC, Canada
  • David Bouhadana Division of Urology, McGill University Health Centre, Montreal, QC, Canada
  • Mélanie Aubé-Peterkin Division of Urology, McGill University Health Centre, Montreal, QC, Canada
  • Fadl Ahmad Hamouche Southern Alberta Institute of Urology, Calgary, AB, Canada

DOI:

https://doi.org/10.5489/cuaj.9350

Keywords:

urinary retention, benign prostatic hyperplasia, wait times, HoLEP, financial burden

Abstract

INTRODUCTION: With rising surgical wait times for benign prostatic hyperplasia (BPH)- related urinary retention (UR), we aimed to assess the healthcare costs of prolonged UR management in patients awaiting holmium laser enucleation of the prostate (HoLEP) and evaluate the impact of wait times on resource utilization and complications.

METHODS: We retrospectively analyzed 91 patients with BPH-related UR on the HoLEP waitlist (September 2021-2024). Wait times, urologic and emergency department (ED) visits, interventions, and costs were recorded. Total costs included institutional and physician-billed fees from our cost center. Continuous variables were reported as mean ± standard deviation or median (interquartile range).

RESULTS: Mean patient age was 71±8 years, with a mean prostate size of 123±54 g. Median wait time from retention to surgery was 220 days (149–300), with median total cost of $5315.95 (4343.85–7385.94). Longer wait times correlated with higher total costs (r=0.374, p<0.001) but inversely with cost per month (r=-0.680, p<0.001), suggesting cumulative burden over time. There were 685 urology clinic visits and 55 ED visits, nine (16%) resulting in hospital admissions. Complications occurred in 51 patients, including infections (63%), hematuria (47%), catheter issues (18%), and urosepsis (16%). Admissions were due to acute kidney injury (AKI) (n=3), urosepsis (n=2), pyelonephritis (n=2), and hematuria (n=2), with pyelonephritis, AKI, and urosepsis contributing the highest costs. Patients with complications required more visits and incurred higher costs (all p<0.05).

CONCLUSIONS: Prolonged UR management significantly increases healthcare costs. Prioritizing earlier surgical intervention may reduce complications, lessen economic strain, and improve patient outcomes.

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Published

2025-12-15

How to Cite

Udupa, S., Fadel, E., Sadri, I., Bouhadana, D., Aubé-Peterkin, M., & Hamouche, F. A. (2025). The financial burden of prolonged urinary retention in patients awaiting holmium laser enucleation of the prostate in the Quebec healthcare system: A retrospective cohort study. Canadian Urological Association Journal, 20(4), 114–21. https://doi.org/10.5489/cuaj.9350

Issue

Vol. 20 No. 4 (2026): CUAJ April

Section

Original Research

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