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Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate.
Eur Urol Focus. 2020 Jun 21 [Online ahead of print]EU

Abstract

BACKGROUND

Scarce data are available about long-term follow-up (FU) in men undergoing holmium laser enucleation of the prostate (HoLEP).

OBJECTIVE

To investigate the risk of being symptomatic at 10-yr FU after HoLEP.

DESIGN, SETTING, AND PARTICIPANTS

Perioperative data from 125 patients submitted to HoLEP in 2007-2010 by a single, highly experienced surgeon were analyzed. Patients were assessed by International Prostate Symptoms Score (IPSS), prostate-specific antigen (PSA), and uroflowmetry at 6-mo and 10-yr FU.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Logistic regression models tested the association between clinically significant predictors and the risk of being symptomatic at long-term FU (defined as IPSS≥8 and/or peak flow rate [PFR]<15ml/s and/or postvoid residual volume [PVR]>20ml, need for symptomatic medical treatment, or redo surgery).

RESULTS AND LIMITATIONS

At surgery, median (interquartile range) age was 66 years (61, 69), prostate volume was 78ml (56, 105), and PFR was 9ml/s (7, 12). All patients showed favorable outcomes (ie, IPSS and uroflowmetry parameters) 6 months after surgery. At median 126-month FU, PFR was 16ml/s (13, 23), PVR was 10ml (5, 15), total IPSS was 5 (1-7), and PSA was 0.7 ng/ml (0.4, 1.3). Of all, 32 patients (26%) were symptomatic at long-term FU, seven (5.7%) reported urinary incontinence, and six (4.7%) underwent redo surgery throughout the FU period due to either bladder neck contracture or urethral stricture. Older patients at surgery (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.03-1.22; p=0.006) and patients who never recovered full continence postoperatively (OR: 0.49; 95% CI: 0.01-0.27; p=0.001) were at a higher risk of being symptomatic at very long-term FU, after adjusting for baseline clinical characteristics.

CONCLUSIONS

HoLEP ensures a durable relief of urinary symptoms in almost 75% of patients up to 10 years after surgery. Older patients and those who do not recover from incontinence after surgery should be counseled carefully regarding a higher risk of symptom recurrence at long-term assessment.

PATIENT SUMMARY

Consistent symptom relief is preserved even 10 years after holmium laser enucleation of the prostate in almost 75% of patients. Older age and incomplete continence recovery after surgery were the two most relevant risk factors for being symptomatic at long-term follow-up. Postoperative functional outcomes are kept in three out of four patients at 10-yr follow-up after holmium laser enucleation of the prostate. Conversely, the older the patient at surgery and the presence of incomplete continence recovery throughout the postoperative period, the greater the probability of being symptomatic at long-term follow-up.

Authors+Show Affiliations

Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy. Electronic address: salonia.andrea@hsr.it.Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32576532

Citation

Fallara, Giuseppe, et al. "Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate." European Urology Focus, 2020.
Fallara G, Capogrosso P, Schifano N, et al. Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. Eur Urol Focus. 2020.
Fallara, G., Capogrosso, P., Schifano, N., Costa, A., Candela, L., Cazzaniga, W., Boeri, L., Belladelli, F., Scattoni, V., Salonia, A., & Montorsi, F. (2020). Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. European Urology Focus. https://doi.org/10.1016/j.euf.2020.05.012
Fallara G, et al. Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. Eur Urol Focus. 2020 Jun 21; PubMed PMID: 32576532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. AU - Fallara,Giuseppe, AU - Capogrosso,Paolo, AU - Schifano,Nicolò, AU - Costa,Antonio, AU - Candela,Luigi, AU - Cazzaniga,Walter, AU - Boeri,Luca, AU - Belladelli,Federico, AU - Scattoni,Vincenzo, AU - Salonia,Andrea, AU - Montorsi,Francesco, Y1 - 2020/06/21/ PY - 2020/04/08/received PY - 2020/05/16/revised PY - 2020/05/27/accepted PY - 2020/6/25/entrez KW - Benign prostatic hyperplasia KW - Holmium laser enucleation of the prostate KW - Lower urinary tract symptoms KW - Prostate JF - European urology focus JO - Eur Urol Focus N2 - BACKGROUND: Scarce data are available about long-term follow-up (FU) in men undergoing holmium laser enucleation of the prostate (HoLEP). OBJECTIVE: To investigate the risk of being symptomatic at 10-yr FU after HoLEP. DESIGN, SETTING, AND PARTICIPANTS: Perioperative data from 125 patients submitted to HoLEP in 2007-2010 by a single, highly experienced surgeon were analyzed. Patients were assessed by International Prostate Symptoms Score (IPSS), prostate-specific antigen (PSA), and uroflowmetry at 6-mo and 10-yr FU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Logistic regression models tested the association between clinically significant predictors and the risk of being symptomatic at long-term FU (defined as IPSS≥8 and/or peak flow rate [PFR]<15ml/s and/or postvoid residual volume [PVR]>20ml, need for symptomatic medical treatment, or redo surgery). RESULTS AND LIMITATIONS: At surgery, median (interquartile range) age was 66 years (61, 69), prostate volume was 78ml (56, 105), and PFR was 9ml/s (7, 12). All patients showed favorable outcomes (ie, IPSS and uroflowmetry parameters) 6 months after surgery. At median 126-month FU, PFR was 16ml/s (13, 23), PVR was 10ml (5, 15), total IPSS was 5 (1-7), and PSA was 0.7 ng/ml (0.4, 1.3). Of all, 32 patients (26%) were symptomatic at long-term FU, seven (5.7%) reported urinary incontinence, and six (4.7%) underwent redo surgery throughout the FU period due to either bladder neck contracture or urethral stricture. Older patients at surgery (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.03-1.22; p=0.006) and patients who never recovered full continence postoperatively (OR: 0.49; 95% CI: 0.01-0.27; p=0.001) were at a higher risk of being symptomatic at very long-term FU, after adjusting for baseline clinical characteristics. CONCLUSIONS: HoLEP ensures a durable relief of urinary symptoms in almost 75% of patients up to 10 years after surgery. Older patients and those who do not recover from incontinence after surgery should be counseled carefully regarding a higher risk of symptom recurrence at long-term assessment. PATIENT SUMMARY: Consistent symptom relief is preserved even 10 years after holmium laser enucleation of the prostate in almost 75% of patients. Older age and incomplete continence recovery after surgery were the two most relevant risk factors for being symptomatic at long-term follow-up. Postoperative functional outcomes are kept in three out of four patients at 10-yr follow-up after holmium laser enucleation of the prostate. Conversely, the older the patient at surgery and the presence of incomplete continence recovery throughout the postoperative period, the greater the probability of being symptomatic at long-term follow-up. SN - 2405-4569 UR - https://www.unboundmedicine.com/medline/citation/32576532/Ten-year_Follow-up_Results_After_Holmium_Laser_Enucleation_of_the_Prostate L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4569(20)30147-4 DB - PRIME DP - Unbound Medicine ER -
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