Trifecta and Pentafecta in HoLEP: Predictors of functional success in a prospective multicentre cohort study.

OBJECTIVE

To evaluate the achievement of the Trifecta and Pentafecta excellence criteria in patients undergoing HoLEP and to determine the preoperative predictive factors for their attainment.

MATERIAL AND

METHODS

A multicentre prospective observational study was conducted. Trifecta criteria were defined as Qmax ≥ 15 mL/s, complete continence, and Clavien-Dindo score < 2 at 3 months. Pentafecta was defined as Trifecta plus a significant response in IPSS and ICIQ-SF. Descriptive and comparative analyses were performed, along with multivariate logistic regression models to identify predictors of success.

RESULTS

A total of 376 patients were included for the Trifecta analysis, with a success rate of 53.2%. Preoperatively, there were no significant differences in the univariate analysis between the Trifecta and non-successful groups in Qmax (8.0 [6.2 - 10.4] vs. 8.15 [6.0 - 10.0] mL/s; p = 0.812), total IPSS (23.0 [17.3 - 28.0] vs. 23.0 [18.0 - 27.3]; p = 0.547), or ICIQ-SF (2.0 [0.0 - 9.5] vs. 4.0 [0.8 - 10.0]; p = 0.118). Postoperatively, the Trifecta group achieved significantly better results in Qmax (27.0 [21.0 - 34.8] vs. 14.0 [9.9 - 23.1] mL/s), IPSS (4.0 [2.0 - 7.0] vs. 8.0 [3.8 - 14.0]), and ICIQ-SF (1.0 [0.0 - 5.0] vs. 5.0 [1.0 - 10.5]), all with p < 0.001. In the multivariate analysis, the absence of previous treatment for storage symptoms (OR: 2.49; 95% CI: 1.18 - 5.23; p = 0.017) was independent predictors of Trifecta achievement. For Pentafecta (n = 245), the success rate was 44.5%, highlighting a lower baseline ICIQ-SF score in the success group (p < 0.001)

CONCLUSION

The absence of previous treatment for storage symptoms was identified as the main independent determinant of surgical excellence in HoLEP.