Impact of Prior Holmium Laser Enucleation of the Prostate on Outcomes After Robot-Assisted Radical Prostatectomy.

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.