Functional outcomes are equivalent after HoLEP regardless of receipt of prior BPH procedure

Functional outcomes were equivalent in patients undergoing holmium laser enucleation of the prostate (HoLEP) after prior failed benign prostatic hyperplasia (BPH) surgery compared with patients who had not undergone prior BPH surgery.¹

The finding was part of a presentation at the 2023 American Urological Association Annual Meeting in Chicago, Illinois.

Nicholas S. Dean, MD

“We're seeing a whole bunch more people presenting to our center for BPH retreatment after failed MISTs [minimally invasive surgical treatments], and also more conventional treatments like TURP [transurethral resection of the prostate] and GreenLight, and so what we wanted to do with our paper is compare HoLEP controls with patients who have had prior procedures and prior MISTs,” study author Nicholas S. Dean, MD, a urologist with Northwestern University Feinberg School of Medicine, told Urology Times®.

Dean and colleagues performed a retrospective examination of patients within an internal review board-approved clinical database who had underwent HoLEP between March 2021 and October 2022. They identified 600 patients who had undergone HoLEP, of whom 145 had undergone a previous procedure for BPH. Forty-six patients underwent a MIST, including 22 prostatic urethral lift procedures, 11 water vapor thermal therapy procedures, 3 robotic waterjet treatment procedures, and 10 prostatic artery embolization procedures.

The primary objective was procedural duration/operative efficiencies. Secondary objectives included rate of successful same-day discharge, same-day catheter removal, length of stay, 90-day complications, and post-operative outcomes.

“Patients with a prior BPH procedure were on average older than our HoLEP controls; however, there were no other differences in preoperative patient characteristics or postoperative functional outcomes,” Dean noted during his presentation. These outcomes included catheter-free status, anti-cholinergic requirements, continence rates, and 90-day complications.

Dean also noted that time from original treatment to HoLEP did not differ among the MIST procedures, but was significantly shorter when comparing MISTs to more conventional treatments such as TURP or photoselective vaporization of the prostate.

“Patients who have had a prior prostatic urethral lift had worse morcellation efficiency and required a greater number of morcellator blades. That being said, their functional outcomes were no different than our HoLEP controls, so it's still a good option for them,” Dean said.

He added, “I think another good take-home from our paper is that patients who had been previously treated had undergone 2.82 procedures on average in the past 5 years. And that kind of just shows you where BPH care is moving. And it's a direction that we're trying to avoid in terms of trying to offer patients a procedure with a very low rate of retreatment like enucleation.”

Reference

1. Assmus M, Dean N, Lee M, Guo J, Krambeck A. Holmium laser enucleation of the prostate (HoLEP) outcomes after minimally invasive surgical therapies (MIST) for BPH. Presented at: American Urological Association Annual Meeting, April 28-May 1, Chicago, Illinois. Abstract MP13-08