Search Results (15,851)

Background: Postoperative delirium (POD) is a common complication in geriatric patients. This prospective cohort study evaluated a possible influence of intraoperative positioning on the occurrence of POD, as intraoperative prone positioning could affect cerebral perfusion. Methods: We included 760 patients of ³60 years scheduled for elective surgery in prone or supine positions. The primary outcome was POD incidence on the first five days after surgery, assessed via 3D-Confusion Assessment Method (3-D CAM) or Confusion Assessment Method for Intensive Care Units (CAM-ICU). Preoperative assessments included the American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) classifications as well as short screenings for the cognitive (modified Montreal Cognitive Assessment (MoCA)) and self-care status of the patient. Secondary outcomes were length of hospital stay (LOS) and mortality rates. Results: Postoperative delirium rates were similar in prone and supine patients (7.6% vs. 5.5%; p = 0.31), and logistic regression analysis revealed no association of intraoperative prone positioning with POD (odds ratio 1.42 (95% CI 0.68–2.92; p = 0.342)). The overall incidence of POD was 6.1% and was associated with older age (81.5 (CI 76.2–84.8) vs. 72.0 (CI 67.0–79.0) years; p < 0.01), higher ASA and NHYA classifications, lower preoperative modified MoCA, reduced independence in self-care (p < 0.001, respectively), and longer incision-to-suture times (107.0 (CI 73.0–173.0) vs. 85.0 (CI 60.0–130.0) minutes; p < 0.01). Postoperative delirium resulted in longer LOS (14.5 (CI 9.0–27.0) vs. 7.0 (CI 4.0–9.0) days; p < 0.001), and increased mortality (13.0% vs. 1.7%; p < 0.001). Conclusions: Intraoperative prone positioning was not associated with POD in patients aged 60 years or older (OR 1.42; CI 0.68–2.92; p < 0.340), and LOS and mortality as secondary outcome parameters were also similar in patients after prone and supine surgery. Future studies assessing additional and possible confounding factors and intraoperative systemic and regional hemodynamics and oxygenation are needed to verify this result and to evaluate cerebral hypoperfusion as a possible mechanism of POD. Full article

Introduction: Hypertrophic cardiomyopathy (HCM) is a common myocardial disease worldwide and is associated with heart failure symptoms and sudden cardiac death. In a subset of patients, it may produce dynamic left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM)-related mitral valve dysfunction through drag forces and altered mitral–septal geometry. In contrast, subaortic stenosis caused by a subaortic membrane is an uncommon congenital lesion that may lead to fixed subvalvular LVOTO in adulthood. The coexistence of these entities is rare and can substantially complicate diagnosis and management. Case presentation: A 51-year-old woman with HCM, paroxysmal atrial fibrillation, and heart failure presented with acute decompensation and cardiogenic shock. After initial hemodynamic stabilization and cardioversion for atrial fibrillation with rapid ventricular response, multimodality imaging with transthoracic and transesophageal echocardiography, coronary computed tomography angiography, and cardiac magnetic resonance demonstrated dual LVOTO, with a dynamic component related to HCM/SAM physiology and a fixed component caused by an elongated subaortic membrane, accompanied by severe SAM-related mitral regurgitation. Echocardiography showed a resting peak LVOT gradient of 49 mmHg, increasing to 85 mmHg with the Valsalva maneuver. After exclusion of obstructive coronary artery disease and evaluation for selected phenocopies, the patient underwent septal myectomy, subaortic membrane resection, and adjunctive mitral valve plication. Early postoperative echocardiography showed reduction in the maximum provoked LVOT gradient to 38 mmHg and improvement of mitral regurgitation from severe to mild. At 3-month follow-up, she remained in sinus rhythm, improved to New York Heart Association functional class II, and had no documented readmissions for heart failure. Conclusions: Combined fixed and dynamic LVOTO due to concomitant subaortic membrane and HCM is exceedingly rare. Accurate diagnosis requires a high index of suspicion and a multimodality imaging strategy to define the obstructive mechanisms and support mechanism-based surgical management and avoid incomplete treatment when a coexisting fixed lesion is present. Full article

Background: Pre-pectoral direct-to-implant breast reconstruction is increasingly adopted after mastectomy because it avoids pectoralis major dissection, reduces postoperative pain, and eliminates animation deformity. However, reconstruction in patients with large or markedly ptotic breasts remains challenging because of skin envelope management, nipple–areola complex (NAC) viability, and implant stability. This study evaluated batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction. Methods: We conducted a retrospective single-center study of consecutive patients who underwent batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction between November 2022 and January 2025. Demographic, oncologic, operative, postoperative, and BREAST-Q data were collected. Primary outcomes included complications, oncologic events, and 12-month patient-reported outcomes. Results: Thirteen patients underwent reconstruction, accounting for 18 breasts, with a mean follow-up of 12.85 months. Mean age was 54.5 ± 9.7 years, mean body mass index was 27.0 ± 3.4 kg/m², and mean Regnault ptosis grade was 3.46 ± 0.52. No seromas or oncologic recurrences were observed. One hematoma and one late infection requiring implant removal occurred. Superficial NAC/central flap epidermolysis developed in four patients and resolved conservatively; no full-thickness NAC necrosis occurred. BREAST-Q scores improved significantly in all domains at 12 months, including satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being (all p < 0.05). Conclusions: Batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane implant reconstruction appears safe and reproducible in selected patients with advanced ptosis, with acceptable complication rates and significant improvement in patient-reported outcomes. Full article

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: “In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?” We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38–3.48; I² = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27–8.70; I² = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received. Full article

Background: Surgical palatal techniques are established alternatives to continuous positive airway pressure (CPAP) in selective patients with obstructive sleep apnea (OSA) with retropalatal airway collapse. Anterior palatoplasty (AP) stiffens and advances the soft palate, whereas radiofrequency-assisted uvulopalatoplasty (RF-UPP) uses thermal ablation to reduce palatal tissue. This study aimed to compare the 6-month efficacy and morbidity of AP vs. RF-UPP in treating mild-to-moderate OSA. Materials and Methods: We conducted a single-center retrospective cohort study (March 2023–March 2025) of 86 adults (mean age ~42 years; 69.8% male) with mild-moderate OSA (apnea–hypopnea index [AHI] 5–30) due to palatal obstruction; 43 patients underwent AP and 43 patients underwent RF-UPP. Polysomnographic AHI, Epworth sleepiness scale (ESS), snoring severity (0–10 visual analog scale, VAS) and sleep-related quality of life (functional outcomes of sleep questionnaire, FOSQ) were analyzed at baseline and 6 months postoperatively. Postoperative pain (0–10 VAS), recovery time, and bleeding events were also assessed. Results: Baseline characteristics were similar between groups (AHI ~22 vs. 21 events/h; ESS ~11 vs. 10; snoring VAS ~8.4 vs. 8.2 in AP vs. RF-UPP, all p > 0.1). At 6 months, the AP group achieved a greater mean AHI reduction than the RF-UPP group (−13.5 ± 7.5 vs. −8.0 ± 7.2, p < 0.001), with post-treatment AHI averaging 8.5 ± 6.0 vs. 13.2 ± 6.5 events/h (AP vs. RF-UPP). AP yielded a higher surgical success rate (34/43 (79.1%) vs. 23/43 (53.5%), p = 0.012), meeting the criteria of ≥50% AHI reduction to <15; p = 0.01. Subjective outcomes improved in both groups, but AP showed greater mean reductions in ESS (−5.5 vs. −3.1 points, p = 0.001) and snoring VAS (−5.7 vs. −3.1, p = 0.002). The improvements in ESS, snoring VAS, and FOSQ scores were observed in both groups, with significantly greater gains after AP. Postoperative pain and time to resumption of normal diet were higher in the AP group. No major complications occurred in either group. Conclusions: Anterior palatoplasty demonstrated superior efficacy to RF-UPP in mild-moderate OSA at the expense of increased postoperative pain and a longer recovery period. AP may offer a greater therapeutic benefit in appropriately selected patients with palatal obstruction. Full article

Background/Objectives: Pericardial effusion (PEf) is a frequent finding after cardiac surgery. Progression to cardiac tamponade (CT) is a rare but life-threatening complication. Current evidence remains limited due to insufficient data on prevalence, progression predictors and management strategies. Methods: We retrospectively analyzed anamnestic, clinical, laboratory, echocardiographic and therapeutic data from 2662 patients (74 ± 11 years) admitted to the Cardiac Rehabilitation ward between 2022 and 2024. Results: Among 2152 (81%) cardiac surgery patients, 382 (18%) developed PEf: 58% mild, 38% moderate, and 4% severe. Patients developing PEf tended to be younger and more frequently male. In addition, PEf development was seen more commonly after aortic and combined surgeries. All patients with severe PEf or CT had undergone surgery via sternotomy, whereas minithoracotomy was inversely associated with PEf severity. Postoperative complications occurred in 92% of PEf patients, mainly due to arrhythmia, hemodynamic deterioration, or heart failure. Overall outcome was favourable in 98% of patients. CT occurred in eight patients (2%). Anticoagulation therapy was more frequent among patients who developed PEf or CT. Preventive colchicine was prescribed in only 16% of cases. No PEf-specific therapy was administered in 56% of PEf patients, while corticosteroids and nonsteroidal anti-inflammatory drugs were used in 28% and 8% of cases, respectively, without surgical wound complications. No PEf recurrences were observed during follow up (517 ± 424 days). Conclusions: PEf is a common complication after cardiac surgery, more frequently in young males, usually of mild or moderate severity. The majority of these cases resolve using either a conservative or pharmacological approach, predominantly via corticosteroids. Patients undergoing aortic surgery, experiencing postoperative complications (especially arrhythmias), and receiving anticoagulation therapy were associated with severe PEf or CT. Despite guideline recommendations, colchicine remains markedly underutilized. Full article

Background/Objectives: Catheter-related bladder discomfort (CRBD) is a common complication that patients with Foley catheters may experience following surgery. Previous studies have suggested that nefopam can reduce the incidence and severity of CRBD; however, dose-dependent effects (20 mg vs. 40 mg) have not been directly compared. Therefore, this study aimed to evaluate the dose-dependent effects of nefopam on CRBD, determine its effective dose, and assess the incidence of associated side effects. Methods: Electronic medical records of patients aged 18–70 years with American Society of Anesthesiologists physical status I–III who underwent elective transurethral ureteroscopic lithotripsy under general anesthesia from August 2016 to December 2022 were reviewed. Patients were categorized into three groups: premedication with intravenous nefopam 20 mg (group N20), premedication with nefopam 40 mg (group N40), or no premedication (control, group C). Results: The incidence rates of CRBD were 85.7% in group C, 81.3% in group N20, and 51.4% in group N40, showing a significant difference among the groups (p = 0.003, Pearson’s chi-squared test). Postoperative NRS was significantly different among the groups (p < 0.001, one-way ANOVA). In post hoc analysis, both group N20 and group N40 showed significantly lower scores compared to group C (p = 0.002, p = 0.001 respectively). The severity of CRBD also decreased in a dose-dependent manner, which was considered significant. No significant differences were observed among the groups in terms of intraoperative hemodynamic stability or postoperative nausea and vomiting. Conclusions: The administration of nefopam 40 mg significantly reduced the incidence and severity of CRBD compared with no premedication. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) following abdominal surgery are associated with prolonged hospitalization, delayed recovery, and increased mortality. Because nursing surveillance is essential for early detection and timely intervention, this study aimed to develop a holistic nursing surveillance decision support system integrating PPC risk prediction with structured nursing action recommendations. Methods: In this retrospective cohort study, electronic medical record (EMR) data from approximately 6900 adult patients who underwent abdominal surgery at a single institution between January 2015 and September 2023 were analyzed. The study protocol was approved by the Institutional Review Board, and the requirement for informed consent was waived because of the retrospective study design. PPC risk was predicted using a tabular multilayer perceptron (MLP) encoder with SHapley Additive exPlanations (SHAP)-based feature weighting and a random forest classification head optimized via Optuna. Class imbalance was addressed using weighted sampling, class weighting in BCE(Binary Cross Entropy) With Logits Loss, and decision-threshold optimization. For clinical decision support, a large language model generated structured nursing surveillance recommendations in an action–evidence–rationale JSON format and was aligned through supervised fine-tuning (SFT) using human-evaluated cases. Results: The prediction model achieved an AUROC of 0.810, with an accuracy of 0.811, precision of 0.547, and recall of 0.545. In expert evaluation, the SFT-aligned model improved recommendation quality, reducing incorrect nursing actions from 19.3% to 8.0%. Conclusions: The proposed system demonstrates the feasibility of an end-to-end nursing surveillance decision support framework linking PPC risk prediction with structured clinical recommendations. The findings suggest its potential to support more accurate risk prediction and more actionable nursing surveillance for patients undergoing abdominal surgery. Full article

Background/Objectives: For men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) requiring surgical intervention, UroLift has been shown to be an effective and durable, minimally invasive method. Methods: A retrospective review was conducted for 72 patients who underwent UroLift at a single hospital in Australia between 2018 and 2025. Data regarding baseline demographics, the pre- and post-operative International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), the post-void residual (PVR), and complications were collected prospectively. Inclusion criteria for patients selected for UroLift were males over 50 years with a prostate volume between 20 and 70 mL, pre-operative PVR of <350 mL and Qmax and IPSSs of <15 mL/s and >12 respectively. The purpose of this study is to assess the clinical outcomes of patients treated with UroLift at our institution and compare these findings to the existing literature. Results: Complete data was available for 34 patients. Our cohort had a median age of 63.0 years (interquartile range [IQR] 58.0–69.0) and UroLift was performed using a median number of 4.05 implants per patient. Median prostate volume (mL) was 43.0 (IQR 38.0–59.0). Post-operatively, the median percentage changes in the IPSS, Qmax (mL/s) and PVR (mL) were −30.9% (IQR 5.8–−71.1, p = 0.0048), 40.1% (IQR −6.6–165.1, p = 0.0159) and −36.4% (IQR −84.6–29.8, p = 0.0232), respectively. Most patients (n = 24, 73.5%) were discharged on the same day of the UroLift procedure with the remainder (n = 9, 26.5%) being discharged on day 1 post-operatively. The median time (months) for post-operative review was 2 (IQR 0.9–3.3). Conclusions: UroLift is safe, effective, and a minimally invasive treatment option in suitable patients with bothersome LUTS requiring surgical intervention. Full article

Background/Objectives: Vasomotor symptoms (hot flashes) affect 70–80% of menopausal women, significantly impairing quality of life. Current treatments include hormone therapy, which is contraindicated for many patients, and non-hormonal alternatives with limited efficacy or adverse effects. Cannabidiol (CBD), a non-psychoactive phytocannabinoid, has emerged as a potential therapeutic candidate due to its interaction with the endocannabinoid system. This study aimed to investigate whether a standardized Cannabis sativa extract containing isolated CBD attenuates heat dissipation in ovariectomized rats, a preclinical model of estrogen deficiency. Methods: Female Wistar rats were randomly assigned to sham-operated vehicle-treated (SHAM-V), ovariectomized vehicle-treated (OVX-V), or ovariectomized CBD-treated (OVX-CBD; 10 mg/kg/day, oral gavage) groups. Treatment began on postoperative day 2 and continued for 21 days. Tail-skin temperature, a surrogate marker of heat dissipation, was assessed by infrared thermography on day 14. Energy metabolism was evaluated by indirect calorimetry on day 21. Uterine weight was measured as a biomarker of estrogen depletion. Results: Ovariectomy significantly increased tail temperature compared to SHAM-V. CBD treatment completely prevented this effect, with OVX-CBD animals exhibiting thermographic profiles similar to SHAM-V. Uterine atrophy was not reversed by CBD. No differences in the calorimetry parameter were observed among groups. Conclusions: This study provides novel preclinical evidence that cannabidiol attenuates ovariectomy-induced heat dissipation in rats, without detectable effects on uterine weight or metabolic parameters. These findings suggest that CBD may represent a potential non-hormonal approach for the management of menopausal vasomotor symptoms; however, further studies are required to elucidate the underlying mechanisms and to determine its translational and clinical relevance. Full article

The reconstruction of complex orbitomaxillary defects requires biomaterials that can simultaneously provide structural stability, biocompatibility, and accurate restoration of facial volume and contour. While rigid polymers such as polyetheretherketone (PEEK) offer reliable mechanical support, they do not adequately replicate the viscoelastic behavior of soft tissues. This report presents a translational revision case employing a personalized hybrid biomaterial approach that combines a 3D-printed PEEK implant for structural orbital floor support with a patient-specific polydimethylsiloxane (PDMS) implant for malar volumetric augmentation. Reconstruction was planned using CT segmentation and contralateral mirroring. Patient-specific implants were subsequently designed using CAD/CAM techniques, combining a rigid PEEK implant for structural orbital support with a flexible PDMS implant for malar volumetric augmentation with complementary mechanical properties. Revision surgery included the removal of inadequately positioned titanium hardware, the release of incarcerated extraocular muscles, and the restoration of orbital anatomy and facial symmetry. Postoperative imaging demonstrated stable implant positioning and sustained orbitomaxillary stability. Despite successful anatomical reconstruction, residual functional sequelae, including strabismus related to the severity of the initial orbital trauma, persisted and were addressed separately in a staged manner, resulting in satisfactory ocular alignment and resolution of diplopia in primary gaze. This case underscores the complementary functional roles of rigid and elastic polymers and highlights the translational potential of PDMS as a permanent, patient-specific implant material for volumetric and contour restoration in craniofacial reconstruction. Full article

Background/Objectives: The subciliary approach offers excellent exposure for orbital and zygomaticomaxillary complex fracture repair but is associated with a relatively high risk of postoperative lower eyelid ectropion. This study evaluated the preventive efficacy of an acellular dermal matrix (ADM; WITHderm^®) spacer graft placed during subciliary incision repair. Methods: This prospective observational cohort study included 20 patients who underwent open reduction and internal fixation for orbital wall or zygomaticomaxillary complex fractures using a subciliary approach between June and December 2024. A human-derived ADM (WITHderm^®) spacer graft was interposed between the orbital septum and the orbicularis oculi muscle during incision closure. Postoperative outcomes were assessed at three time points: ectropion grading at 1 month and scar outcomes at 3 and 6 months using the Patient and Observer Scar Assessment Scale (POSAS). Results: No patients developed postoperative lower eyelid ectropion at 1-month follow-up (0% incidence). Both patient-reported and observer-reported scar outcomes improved significantly over time. The mean total PSAS score decreased from 21.0 ± 2.85 at 3 months to 11.3 ± 2.13 at 6 months (p < 0.001), while the mean total OSAS score decreased from 21.35 ± 2.25 to 11.4 ± 1.67 (p < 0.001). Overall patient satisfaction and objective scar ratings also showed significant improvement. Conclusions: ADM (WITHderm^®) spacer grafting during subciliary incision repair appears to be a safe and effective strategy for preventing early postoperative lower eyelid ectropion and achieving favorable scar outcomes. Further studies are warranted to confirm these findings. Full article

Objective: This study investigates the prognostic value and clinical utility of the neutrophil percentage-to-albumin ratio (NPAR) in patients with resected non-small-cell lung cancer (NSCLC). Methods: We retrospectively included 335 patients with NSCLC who underwent lung resection at our institution between January 2017 and October 2018. Optimal cutoffs for preoperative and postoperative day 1 (D1) NPAR were determined using X-tile (version 3.6.1; Yale University, New Haven, CT, USA) to define high and low groups. Overall survival (OS) was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. A perioperative NPAR trajectory (low–low, low–high, high–low, high–high) was constructed to characterize dynamic risk patterns. To mitigate potential bias associated with postoperative measurements, a D1 landmark analysis was performed. A nomogram was developed based on the multivariable model and assessed by calibration at 1, 3, and 5 years. Incremental clinical value beyond TNM stage and surgical approach was evaluated using decision curve analysis (DCA), as well as by 5-year continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: The optimal cutoffs for preoperative and postoperative D1 NPAR were 14.5 and 23.1, respectively. In univariate analyses, sex, smoking history, preoperative NPAR, postoperative D1 NPAR, pathologic type, TNM stage, surgical approach, and adjuvant therapy were associated with OS (all p < 0.01). In multivariable Cox regression, high preoperative NPAR (HR 1.896, 95% CI 1.135–3.168; p = 0.014) and high postoperative D1 NPAR (HR 1.905, 95% CI 1.097–3.305; p = 0.014) were independent risk factors, along with TNM stage (Stage II: HR 2.824, 95% CI 1.209–6.595; p = 0.016; Stage III: HR 9.470, 95% CI 4.935–18.171; p < 0.001) and open surgery (HR 2.350, 95% CI 1.341–4.117; p = 0.003). Trajectory analysis further stratified risk, with the high–high group showing the poorest survival (adjusted HR 3.48, 95% CI 1.43–8.47; p = 0.006). The association of postoperative NPAR persisted in the D1 landmark analysis (HR 1.836, 95% CI 1.071–3.148; p = 0.027). Adding NPAR to TNM stage and surgical approach improved 5-year risk reclassification (continuous NRI 0.377, 95% CI 0.094–0.659; IDI 0.028, 95% CI −0.002–0.054) and increased net benefit on DCA. The nomogram demonstrated acceptable calibration at 1, 3, and 5 years. Conclusions: This study demonstrates that NPAR serves as an independent prognostic marker for long-term outcomes in patients with NSCLC. The use of NPAR offers clinicians a comprehensive and precise tool for assessing patient prognosis. Full article

Background/Objectives: Obesity has been associated with the development and severity of benign prostatic hyperplasia (BPH), yet its influence on outcomes following definitive surgical management, like holmium laser enucleation of the prostate (HoLEP), remains unclear. Furthermore, gradation of body mass index (BMI) severity has yet to discern personalized outcome stratification. We evaluated BMI’s influence on perioperative, immediate, short-term follow-up, and patient-reported outcomes for HoLEP patients. Methods: We performed a retrospective review of a prospectively maintained database of patients undergoing HoLEP for BPH at a single institution between January 2021 and August 2025. Outcomes included operative characteristics, post-operative complications, and validated symptom score changes. Analyses treated BMI as both a continuous and categorical variable. Multivariable linear and logistic regression models adjusted for common colinear confounders. Results: Among 1445 patients, BMI was not associated with most immediate, three-month, or patient-reported outcomes. Surgical complications were low across all BMI categories, and post-operative reported outcomes indicating high success rate for HoLEP. Higher BMI correlated with a modest increase in enucleation time (β = 0.197; p = 0.0132), increased odds of dysuria (OR = 1.084; p < 0.001), and change in American Urological Association Symptom Score (β = 0.211; p = 0.0334). All other operative metrics, complication rates, continence outcomes, and symptom scores (17 other total) were independent of BMI. Conclusions: After adjustment for relevant confounders, BMI does not meaningfully predict surgical safety, functional recovery, or patient-reported benefit following HoLEP. BMI alone should not influence candidacy or risk stratification for HoLEP in patients with BPH, instead favoring personalized, risk-stratified approaches. Full article