PURPOSE: To determine risk factors of re-operation after holmium laser enucleation of the prostate (HoLEP) for management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) with time to event analysis.
METHODS: A prospectively maintained database was reviewed for patients undergoing HoLEP. Baseline and follow-up data were compared in terms of International Prostate Symptoms Score, quality of life, peak flow rate, residual urine, and prostate-specific antigen (PSA) at 1, 6, and 12-months and then annually. Perioperative and late adverse events were recorded. Re-operation was defined as the need for any surgical intervention to relieve bothersome LUTS after HoLEP. Multivariate logistic regression was used to determine covariates associated with re-operation and the Kaplan-Meier curve assessed the time to re-operation.
RESULTS: A total of 1216 HoLEP procedures were performed between March 1998 and October 2013 with a mean prostate volume of 94.8±52.7 cc. Catheter time and hospital stay were 1.4±1.9 and 1.3±1.6 days, respectively. After a median follow-up of 7.6 years (1-14 years), 52 (4.3%) patients needed re-operation for recurrent LUTS, including 13 (1.07%) for residual/recurrent adenoma, 14 (1.15%) for bladder neck contracture (BNC), and 25 (2.05%) for de novo urethral stricture. In multivariate regression, smaller prostate size (< 62 cc), PSA reduction < 50%, and history of previous prostate surgery were significantly associated with recurrence of adenoma. BNC was significantly associated with smaller glands (< 54 cc) while longer operative time and postoperative catheterization were significantly associated with urethral stricture. Kaplan-Meier curve demonstrates post-HoLEP freedom from reoperation of 96.9% at 5 years and 95.1% at 10 years.
CONCLUSIONS: In a single center large series, HoLEP has 95% re-operation-free probability at 10 years. Relatively small-size prostate may have an impact on recurrence of adenoma and bladder neck contracture. PSA reduction < 50% was significantly associated with recurrence of adenoma while longer operative time and postoperative catheterization were significantly associated with postoperative urethral stricture.
Written by:
Elkoushy MA, Elshal AM, Elhilali MM. Are you the author?
Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Quebec, Canada.
Reference: J Endourol. 2015 Apr 2. Epub ahead of print.
doi: 10.1089/end.2015.0060
PubMed Abstract
PMID: 25705817