J Korean Geriatr Soc.  2014 Dec;18(4):199-204. 10.4235/jkgs.2014.18.4.199.

Outcomes of the Holmium Laser Enucleation of the Prostate for Patients With Prior Benign Prostatic Hyperplasia Surgery

• Moon KY
• Kim DY
• Yoon JH
• Na W
• Lee JB

• KMID: 2064149
• DOI: http://doi.org/10.4235/jkgs.2014.18.4.199

Abstract

BACKGROUND
To assess the functional outcomes and morbidity in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery.
METHODS
Patients were stratified into two groups, 558 patients who underwent primary HoLEP (group I) and 50 patients who underwent 'secondary-HoLEP' with prior transurethral prostate surgery (group II).
RESULTS
There were no significant differences in the preoperative parameters (median age, International Prostate Symptom Score [IPSS], prostate-specific antigen [PSA], prostate volume, maximum urinary flow rate [Qmax], and postvoid residual urine volume [PVR]). No significant intraoperative differences were noted in the use of total energy, resected volume, enucleation time, resection efficiency, and mean catheterization time. There were significant improvements in Qmax, PVR, and IPSS in both groups. Complications in groups I and II included 19 (3.1%) and 1 (2.0%) bladder injuries, 25 (4.4%) and 2 (4.0%) recatheterization for transient voiding difficulty, 20 (3.5%) and 2 (4%) cases of severe hematuria requiring additional treatment, and 5 (0.8%) and 0 cases for remorcellation due to remaining adenoma. Transient incontinence was the most common complication for both groups I and II, 30 cases (5.4%) and 3 cases (6.0%) respectively. Urinary tract infection showed improvement subsequent to antibiotic treatment. During the 6 month follow-up period, urethral stricture occurred in 7 cases (1.3%) for group I and in 1 case (2.0%) for group II.
CONCLUSION
There were no significant differences in functional outcomes and morbidity between the two groups. 'Secondary-HoLEP' seems to be effective and safe for patients with prior BPH surgery.

Keyword

Holmium laser enucleation; Postoperative complications; Prostate; Transurethral prostate resection

MeSH Terms

Adenoma
Catheterization
Catheters
Follow-Up Studies
Hematuria
Humans
Lasers, Solid-State*
Postoperative Complications
Prostate*
Prostate-Specific Antigen
Prostatic Hyperplasia*
Transurethral Resection of Prostate
Urethral Stricture
Urinary Bladder
Urinary Tract Infections
Prostate-Specific Antigen