Long-term outcomes of Holmium laser enucleation of prostate and predictive model for symptom recurrence.
Aged
Humans
Laser Therapy
/ adverse effects
Lasers, Solid-State
/ therapeutic use
Long Term Adverse Effects
/ diagnosis
Lower Urinary Tract Symptoms
/ etiology
Male
Organ Size
Outcome and Process Assessment, Health Care
Postoperative Complications
/ diagnosis
Prognosis
Prostate
/ pathology
Prostatic Hyperplasia
/ pathology
Recurrence
Reoperation
/ methods
Symptom Assessment
/ methods
benign prostatic hyperplasia
holmium laser enucleation of prostate
long-term outcomes
lower urinary tract symptoms
predictors
Journal
The Prostate
ISSN: 1097-0045
Titre abrégé: Prostate
Pays: United States
ID NLM: 8101368
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
revised:
20
09
2021
received:
19
05
2021
accepted:
04
10
2021
pubmed:
26
10
2021
medline:
22
2
2022
entrez:
25
10
2021
Statut:
ppublish
Résumé
Holmium laser enucleation of prostate (HoLEP) represents one of the most studied surgical techniques for benign prostatic hyperplasia (BPH). Its efficacy in symptom relief has been widely depicted. However, few evidence is available regarding the possible predictors of symptom recurrence. We aimed to evaluate long-term outcomes, symptom recurrence rate, and predictors in patients that underwent HoLEP. We retrospectively analyzed data from patients that consecutively underwent HoLEP for BPH from 2012 to 2015 at two tertiary referral centers. Functional outcomes were evaluated by uroflowmetry parameters and International Prostate Symptom Score (IPSS) questionnaire administration at follow-up visits at 12, 24, and 60 months. The primary outcome was the symptomatic patients' rate presenting lower urinary tract symptoms (LUTS) after 60 months from surgery, defined as in case of one or more of the following: IPSS more than 7, post voidal residue (PVR) more than 20 ml, need for medical therapy for LUTS or redo surgery for bladder outlet obstruction. Multivariable logistic regression analyses evaluated predictors for being symptomatic at follow-up. Covariates consisted of: preoperative peak flow rate (PFR), PVR, and IPSS, prostate volume, age (all as continuous), and surgical technique. A total of 567 patients were available for our analyses. Median prostate volume was 80cc, with a median PFR of 8 ml/s and median PVR of 100cc. One hundred and twenty-five (22%) patients were found to be symptomatic at follow-up. Redo surgery was needed for 25 (4.4%) patients. After adjusting for possible confounders, an increase in preoperative PVR (odds ratio [OR] 1.005) and IPSS (OR 1.12) resulted as independent predictors for symptom recurrence (all p < 0.001). HoLEP can provide durable symptom relief regardless of the chosen technique. Patients with an important preoperative symptom burden or a high PVR should be carefully counseled on the risk of symptom recurrence.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
203-209Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Calogero AE, Burgio G, Condorelli RA, Cannarella R, Vignera LS. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male. 2019;22(1):12-19.
Naspro R, Suardi N, Salonia A, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol. 2006;50(3):563-568.
Schiavina R, Bianchi L, Giampaoli M, et al. Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy. Arch Ital Urol E Androl [Internet]. 2020;92(2):32597105. https://www.pagepressjournals.org/index.php/aiua/article/view/aiua.2020.2.82
Zhong J, Feng Z, Peng Y, Liang H. A systematic review and meta-analysis of efficacy and safety following Holmium laser enucleation of prostate and transurethral resection of prostate for benign prostatic hyperplasia. Urology. 2019;131:14-20.
Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183(3):1105-1109.
Fallara G, Capogrosso P, Schifano N, et al. Ten-year follow-up results after Holmium laser enucleation of the prostate. Eur Urol Focus. 2020;7:612-617.
Romero-Otero J, García-Gómez B, García-González L, et al. Critical analysis of a multicentric experience with holmium laser enucleation of the prostate for benign prostatic hyperplasia: outcomes and complications of 10 years of routine clinical practice. BJU Int. 2020;126(1):177-182.
Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol. 2007;52(5):1465-1472.
Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology. 1996;47(1):48-51.
Piazza P, Bianchi L, Giampaoli M, et al. Short time delay between previous prostate biopsy for prostate cancer assessment and Holmium laser enucleation of the prostate correlates with worse perioperative outcomes. Eur Urol Focus. Published online April 12, 2021.
Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 2010;105(5):584-585.
Schiavina R, Droghetti M, Novara G, et al. The role of multiparametric MRI in active surveillance for low-risk prostate cancer: the ROMAS randomized controlled trial. Urol Oncol. 2020;39:433.
Borghesi M, Bianchi L, Barbaresi U, et al. Diagnostic performance of MRI/TRUS fusion-guided biopsies vs. systematic prostate biopsies in biopsy-naïve, previous negative biopsy patients and men undergoing active surveillance. Minerva Urol Nephrol. 2021;73:357-366.
Bianchi L, Chessa F, Angiolini A, et al. The use of augmented reality to guide the intraoperative frozen section during robot-assisted radical prostatectomy. Eur Urol. 2021;80(4):480-488.
Schiavina R, Bianchi L, Lodi S, et al. Real-time augmented reality three-dimensional guided robotic radical prostatectomy: preliminary experience and evaluation of the impact on surgical planning. Eur Urol Focus. Published online August 31, 2020.
Ibrahim A, Alharbi M, Elhilali MM, Aubé M, Carrier S. 18 years of Holmium laser enucleation of the prostate: a single center experience. J Urol. 2019;202(4):795-800.
Elmansy HM, Kotb A, Elhilali MM. Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of follow-up. J Urol. 2011;186(5):1972-1976.
Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109(3):408-411.
Aldamanhori R, Chapple CR. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol. 2017;27(3):293-299.
Andersson K-E, Boedtkjer DB, Forman A. The link between vascular dysfunction, bladder ischemia, and aging bladder dysfunction. Ther Adv Urol. 2017;9(1):11-27.
Kuntz RM. Laser treatment of benign prostatic hyperplasia. World J Urol. 2007;25(3):241-247.
Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol. 2015;33(4):487-493.
Elkoushy MA, Elshal AM, Elhilali MM. Reoperation after holmium laser enucleation of the prostate for management of benign prostatic hyperplasia: assessment of risk factors with time to event analysis. J Endourol. 2015;29(7):797-804.
Piao S, Choo MS, Kim M, Jeon HJ, Oh S-J. Holmium laser enucleation of the prostate is safe for patients above 80 years: a prospective study. Int Neurourol J. 2016;20(2):143-150.
Mmeje CO, Nunez-Nateras R, Warner JN, Humphreys MR. Age-stratified outcomes of holmium laser enucleation of the prostate. BJU Int. 2013;112(7):982-989.
Das AK, Teplitsky S, Chandrasekar T, et al. Stress urinary incontinence post-Holmium laser enucleation of the prostate: a single-surgeon experience. Int Braz J Urol Off J Braz Soc Urol. 2020;46(4):624-631.
Cho MC, Park JH, Jeong MS, et al. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn. 2011;30(7):1343-1349.