Elsevier

Urology

Volume 81, Issue 5, May 2013, Pages 1025-1029
Urology

Prostatic Diseases and Male Voiding Dysfunction
Holmium Laser Enucleation of the Prostate for Persistent Lower Urinary Tract Symptoms After Prior Benign Prostatic Hyperplasia Surgery

https://doi.org/10.1016/j.urology.2013.01.019Get rights and content

Objective

To evaluate comparative safety and outcomes in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery.

Methods

We identified 37 patients who underwent HoLEP for persistent lower urinary tract symptoms (LUTS) after previous transurethral prostate surgery for benign prostatic hyperplasia (group I). Patients were then matched according to preoperative transrectal ultrasound prostate size to 74 patients without prior surgery who underwent HoLEP (group II). A retrospective chart review was performed.

Results

In group I, no patients had previously undergone HoLEP, and 9 (24%) had undergone >1 surgery for benign prostatic hyperplasia (BPH). There were no significant differences in age, preoperative mean urinary flow, or preoperative prostate-specific antigen (PSA) value between groups I and II. There were no significant differences in perioperative parameters, including resected tissue weight (61.7 vs 63.9 grams, P = .83) or enucleation rate (1.32 vs 1.36 g/min, P = .76). There was no significant difference in mean catheterization time or length of hospital stay. Postoperative peak flow (23.4 vs 26.9 mL/sec, P = .14) and post-void residual (PVR, 50.9 vs 50.3 mL, P = .61) were improved and similar between groups. American Urological Association Symptom Indices (AUASIs) were improved in both groups, although the primary group was significantly lower (7.52 vs 5.21, P = .0060). There was no significant difference in adverse events. All patients were urinating at last follow-up (mean 18.4 and 15.1 months, P = .16).

Conclusion

HoLEP is safe and effective at relieving persistent LUTS after failed previous BPH surgery. Outcomes similar to those of a primary HoLEP procedure can be expected.

Section snippets

Material and Methods

After receiving institutional review board approval, a retrospective review of all patients who had undergone HoLEP for symptomatic BPH from 2009 to 2012 at our institution was performed. Thirty-seven patients with a history of surgery for BPH were identified and stratified into a cohort (group I). These patients were then matched 2:1 with patients having undergone HoLEP with no history of surgery for BPH (group II) according to prostate size on preoperative transrectal ultrasound.

All HoLEP

Results

Table 1 lists patient characteristics. There were no significant differences between the 2 groups for mean age, mean AUASI, average urinary flow, prostate volume, prostate-specific antigen (PSA), presence of concomitant bladder stone, body mass index, or presence of preoperative urinary retention requiring clean intermittent catheterization or indwelling urethral catheterization. The mean preoperative peak urinary flow rate and PVR urine in group I were significantly higher and lower,

Comment

The current study demonstrates postoperative urinary parameters comparable to other series at relatively short-term follow-up. Both postoperative maximum urinary flow rate and AUASI in the secondary HoLEP group were greatly improved compared to preoperative values. These were similar to results seen in the group without prior surgery, although AUASI score was higher in the prior surgery group. PVR urine measurements were also greatly improved in each group, with no significant difference noted

Conclusions

HoLEP for recurrent LUTS after prior surgery for BPH is safe and effective. Our study demonstrates similar efficacy and incidence of complications regardless of prior transurethral prostate surgery, and a history of surgery should not preclude using HoLEP for recurrent LUTS associated with adenomatous regrowth.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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