Urology · 2025
Feasibility of Holmium Laser Enucleation of the Prostate After Prior Prostate Intervention for Benign Prostatic Hyperplasia.
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Mokhtarzadehazar Peyman, Ferguson Blake, Davis Garrett, El Tayeb Marawan M
Аннотация
OBJECTIVE: To evaluate the safety and outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with a history of prior surgical prostate intervention, and to compare these results with the patients without previous prostate intervention.
METHODS: A retrospective review of a prospectively maintained database at a tertiary-level center in Texas. From August 2015 to February 2025, 1876 patients underwent HoLEP, 143 had previous prostate surgery. These were matched 1:1 with 143 patients without prior surgery based on prostate weight. Data included IPSS, hemoglobin reduction, resected tissue weight, enucleation and morcellation efficacy, prostate volume, and estimated blood loss (EBL).
RESULTS: A total of 286 patients. Of 143 patients with prior surgery, TURP was the most common procedure (82 cases). No significant differences were found between groups in preoperative IPSS, age, resected weight, enucleation efficacy, hemoglobin reduction, or prostate volume. At 3 months postoperatively, the IPSS was significantly lower in patients with prior surgery. Morcellation efficacy was reduced, and EBL was higher in the prior surgery group. Both groups demonstrated significant improvements in IPSS overall.
CONCLUSION: HoLEP is a safe and effective surgical option for BPH in both primary and re-treatment settings. Prior interventions do not significantly affect enucleation efficacy, hemoglobin reduction, or IPSS outcomes; however, they are associated with reduced morcellation efficiency and increased blood loss.
METHODS: A retrospective review of a prospectively maintained database at a tertiary-level center in Texas. From August 2015 to February 2025, 1876 patients underwent HoLEP, 143 had previous prostate surgery. These were matched 1:1 with 143 patients without prior surgery based on prostate weight. Data included IPSS, hemoglobin reduction, resected tissue weight, enucleation and morcellation efficacy, prostate volume, and estimated blood loss (EBL).
RESULTS: A total of 286 patients. Of 143 patients with prior surgery, TURP was the most common procedure (82 cases). No significant differences were found between groups in preoperative IPSS, age, resected weight, enucleation efficacy, hemoglobin reduction, or prostate volume. At 3 months postoperatively, the IPSS was significantly lower in patients with prior surgery. Morcellation efficacy was reduced, and EBL was higher in the prior surgery group. Both groups demonstrated significant improvements in IPSS overall.
CONCLUSION: HoLEP is a safe and effective surgical option for BPH in both primary and re-treatment settings. Prior interventions do not significantly affect enucleation efficacy, hemoglobin reduction, or IPSS outcomes; however, they are associated with reduced morcellation efficiency and increased blood loss.