Outcomes of HoLEP in the Retreatment Setting

Holmium laser enucleation of the prostate (HoLEP) can also be applied in the retreatment setting when other BPH therapies fail. We sought to compare outcomes of men undergoing HoLEP in the primary versus retreatment setting (pHoLEP versus rHoLEP).

A retrospective review of 2,242 patients undergoing HoLEP at four academic hospitals between 2003 and 2015 was performed. Patient demographic, operative and perioperative outcomes between rHoLEP and pHoLEP were compared.

The majority of the 360 (16%) men undergoing rHoLEP did so for residual urinary symptoms (71%). The most commonly primary procedure was transurethral resection of the prostate (42%). Mean time between prior BPH surgery and rHoLEP was 68 months (1-444 months). There were no significant differences in age, prostate size, AUA symptom score (AUASS), or average flow rate between cohorts. Perioperatively, rHoLEP was associated with significantly shorter operative times, reduced blood loss, lower specimen weight, and shorter length of stay. AUASS improved in both groups, though remained higher for men undergoing rHoLEP (6.5 versus 5.0, P < 0.001). Likelihood of clot retention (4.7% versus 1.8%, P = 0.01) and urethral stricture (3.3% versus 1.5%, P = 0.043) were slightly higher in the rHoLEP group.

Immediate perioperative outcomes for HoLEP performed in the retreatment setting are no different from those in the primary setting. While rHoLEP was associated with increases in likelihood of clot retention, urethral stricture, and AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

The Journal of urology. 2016 Dec 30 [Epub ahead of print]

Tracy Marien, Mustafa Kadihasanoglu, Teerayut Tangpaitoon, Nadya York, Andrew T Blackburne, Haidar Abdul-Muhsin, Michael S Borofsky, Amy E Krambeck, Mitchell R Humphreys, James E Lingeman, Nicole L Miller

Vanderbilt University Medical Center, Nashville, TN., Indiana University School of Medicine, Indianapolis, IN., Mayo Clinic, Rochester, MN., Mayo Clinic, Scottsdale, AZ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: .