International journal of urology : official journal of the Japanese Urological Association · 2026
Impact of Prior Holmium Laser Enucleation of the Prostate on Outcomes After Robot-Assisted Radical Prostatectomy.
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Nishino Takato, Shimbo Masaki, Oguchi Tomohiko, Sano Masayuki, Narimoto Kazutaka, Hattori Kazunori, Endo Fumiyasu
Аннотация
OBJECTIVES: We investigated whether prior holmium laser enucleation of the prostate (HoLEP) influences perioperative, oncologic, and continence outcomes following robot-assisted radical prostatectomy (RARP).
METHODS: A total of 419 patients who underwent RARP, including 27 with prior HoLEP, were retrospectively analyzed using 1:2 propensity score matching. Urinary continence was assessed longitudinally using pad counts at scheduled intervals, with 12-month continence as the primary endpoint. Secondary endpoints included perioperative outcomes and biochemical recurrence (BCR).
RESULTS: No significant differences were observed in perioperative outcomes, pathological findings, or BCR-free survival between patients with and without prior HoLEP. At 12 months, functional continence (≤ 1 pad/day) was achieved in 100.0% of patients without prior HoLEP and in 85.2% of those with prior HoLEP (p = 0.011). Kaplan-Meier analysis demonstrated no significant difference in time to recovery (log-rank p = 0.068); however, a subset of patients with prior HoLEP experienced persistent incontinence beyond 12 months. Exploratory analyses implied an association between longer adjunctive transurethral coagulation time during HoLEP and worse functional continence.
CONCLUSIONS: Perioperative and oncologic outcomes after RARP were generally comparable regardless of prior HoLEP in this cohort. However, persistent incontinence at 12 months may occur in a subset of patients with prior HoLEP.
METHODS: A total of 419 patients who underwent RARP, including 27 with prior HoLEP, were retrospectively analyzed using 1:2 propensity score matching. Urinary continence was assessed longitudinally using pad counts at scheduled intervals, with 12-month continence as the primary endpoint. Secondary endpoints included perioperative outcomes and biochemical recurrence (BCR).
RESULTS: No significant differences were observed in perioperative outcomes, pathological findings, or BCR-free survival between patients with and without prior HoLEP. At 12 months, functional continence (≤ 1 pad/day) was achieved in 100.0% of patients without prior HoLEP and in 85.2% of those with prior HoLEP (p = 0.011). Kaplan-Meier analysis demonstrated no significant difference in time to recovery (log-rank p = 0.068); however, a subset of patients with prior HoLEP experienced persistent incontinence beyond 12 months. Exploratory analyses implied an association between longer adjunctive transurethral coagulation time during HoLEP and worse functional continence.
CONCLUSIONS: Perioperative and oncologic outcomes after RARP were generally comparable regardless of prior HoLEP in this cohort. However, persistent incontinence at 12 months may occur in a subset of patients with prior HoLEP.