BERKELEY, CA (UroToday.com) - Benign prostatic hyperplasia is a common condition with surgical therapy generally reserved for men failing medical management. Unfortunately, while often successful in short-term follow-up, many BPH procedures fail to control symptoms adequately in longer follow-up, necessitating repeat procedures anywhere from 6 to 21% of the time depending on the procedure.
Holmium laser enucleation of the prostate (HoLEP) is a modern laser therapy for surgical treatment of benign prostatic hyperplasia in men. Data suggest equal efficacy to the historical gold standard, transurethral resection of the prostate. While excellent results have been seen in men without prior BPH surgery, little evidence exists examining if there are worse outcomes in men with a history of a failed previous BPH procedure. This is of importance due to the relative frequency men undergo a repeat procedure for recurrent symptoms of BPH.
We utilized a matched, case-control method to study the effect a prior procedure may have on HoLEP. In HoLEP, enucleation occurs by removing adenomatous tissues from the surrounding capsule. As many surgical treatments do not resect or vaporize prostate tissue to this anatomical extent, we found no increase in difficultly of laser enucleation. Additionally, there was no significant difference in morcellation rate, a possible surrogate to the composition of prostate tissue removed. Consistent with the observation of minimal tissue change, we found prior surgery had little effect on clinical outcomes. All men noted improvement in symptoms and objective urinary parameters similar to the primary cohort.
Overall, this study suggests that men treated with HoLEP, as a repeat procedure, may expect results similar to those treated in the primary setting. Thanks to these results, we can confidently counsel patients undergoing HoLEP following a prior procedure that they should experience no decreased benefit. With new technology in endoscopic BPH therapy progressing at a rapid rate, specific patient populations such as this one will need to be examined to determine if efficacy is consistent.
Written by:
Christopher D. Jaeger, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
The Department of Urology, Mayo Clinic School of Medicine, Rochester, MN
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