Prostatic Diseases and Male Voiding DysfunctionHolmium Laser Enucleation of the Prostate for Persistent Lower Urinary Tract Symptoms After Prior Benign Prostatic Hyperplasia Surgery
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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Cited by (26)
Predictors of Storage Symptom Improvement After Plasma Kinetic Enucleation of the Prostate
2022, UrologyCitation Excerpt :There are few studies examining the storage symptoms outcomes in re-operative cases, especially for PKEP. In the HoLEP population, this has been studied and found similar improvement to first time operations.15 However, this was a size-matched comparison.
Low-Power Vs High-Power Holmium Laser Enucleation of the Prostate: Critical Assessment through Randomized Trial
2018, UrologyCitation Excerpt :Reports of contemporary HoLEP series were reviewed for enucleation efficiency and laser setting. Table 2 highlights enucleation efficiency in different series in relation to treated prostate volume, level of experience of treating surgeons, and utilized laser power.9,18-27 In this study we did not include patients with bleeding tendency, prostate cancer, and with history of previous prostate surgery.
Safety and Effectiveness of Holmium Laser Enucleation of the Prostate Using a Low-power Laser
2017, UrologyCitation Excerpt :Regarding enucleation efficiency, we were able to obtain acceptable results compared with other reports using a high-power laser. The efficiency of enucleation with a high-power laser was reported as 0.34 g/min to nearly 1.48 g/min using a laser of 100 W or 120 W.7,10,11,13 These results showed that enucleation efficiency was 1.14 g/min, which is an acceptable outcome even at 30 W. There has been little debate about the appropriate output of the laser in HoLEP.
Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting
2017, Journal of UrologyCitation Excerpt :There was no difference between rHoLEP and pHoLEP in urinary tract infections, bladder neck contracture or new urinary incontinence postoperatively. Jaeger and Krambeck,7 and Elshal et al8 also found similar low rates of complications without any difference compared to men undergoing primary treatment. A statistical difference between the rates of postoperative clot retention and urethral stricture was likely detected in this series, given the much larger number of patients.
Financial Disclosure: The authors declare that they have no relevant financial interests.