Among 286 patients undergoing HoLEP, two cohorts were analyzed: 143 patients with prior prostate surgery and 143 without prior surgery. Morcellation efficacy was significantly higher in patients undergoing HoLEP without prior surgery (6.00 [4.73–8.46] vs 5.11 [3.63–7.00], P = .0014). Estimated blood loss was higher in the prior-surgery group. At 3 months postoperatively, IPSS was significantly lower in patients with prior surgery (7.00 [4.00–10.00] vs 9.00 [4.00–13.00], P = .0185). No other perioperative variables differed significantly between groups, including Hemoglobin reduction, Enucleation efficacy, and prostate volume.
Prior surgical treatment does not compromise enucleation efficiency, postoperative symptom improvement, or hemoglobin reduction, confirming the reliability of HoLEP despite previous tissue disruption. However, reduced morcellation efficiency and increased estimated blood loss are observed in previously treated patients, likely due to intraprostatic adhesions and altered tissue characteristics, resulting in slightly longer operative times. These findings underscore the need for careful hemostasis and anticipation of extended morcellation during re-treatment.
Written by: Peyman Mokhtarzadehazar, Blake Ferguson, Garrett Davis, and Marawan M. El Tayeb
- Baylor Scott and White Health, Temple, TX