HoLEP An Option After Failed Prior BPH Surgery

CHICAGO—Holmium laser enucleation of the prostate (HoLEP) surgery may be safe and effective at relieving persistent lower urinary tract symptoms (LUTS) after previous unsuccessful surgery for benign prostatic hyperplasia (BPH), according to a new study presented at the North Central Section of the American Urological Association's annual meeting.

The study compared surgical and postsurgical outcomes among patients who had a previous unsuccessful surgery for enlarged prostate and a group with no previous surgery.

“Other than a clinically and statistically insignificant slower morcellation rate … and a mean urine flow rate for patients who had a previous surgery, the study found no difference in outcomes between the groups," said senior study author Amy Krambeck, MD, Associate Professor of Urology at the Mayo Clinic, Rochester, Minn. 

Dr. Krambeck and her colleagues compared perioperative and postoperative outcomes in patients who under underwent holmium laser enucleation of the prostate between 2009 and 2012.  In this retrospective review, patients were grouped according to their history of prior prostate surgery.  One group included those with prior BPH surgery and the other group included those patients who had no previous BPH surgery. A total of 37 patients with prior BPH surgery (mean age 71 years) were matched to 36 individuals without prior surgery (mean age 69 years) based on preoperative characteristics.

The researchers observed no significant difference in operative or postoperative complications, but the morcellation rate appeared to be slower in the prior surgery group (4.1 vs. 5.0 g/min); however this was not statistically significant. The study found no significant differences in length of catheterization between the prior surgery group and the group without prior surgery (1.3 vs. 1.1 days) and showed that all patients were urinating at last follow-up.

“We were not surprised by the findings,” Dr. Krambeck told Renal & Urology News.  “I personally think if we could get more centers to adopt this technique we could have better outcomes for our patients. Even though the patient has failed a prior BPH surgery, the risk of bleeding, incontinence, or overall complications are not increased if they have a holmium laser enucleation surgery.”

The postoperative peak flow (23.4 vs. 26.9 mL/sec) and post void residual (51 vs. 50 mL) were not significantly different between groups. The average flow was slightly slower in the group with prior surgery (12.7 vs. 15.9 mL/sec); however, this was not statistically significant. Postoperative American Urology Association symptom scores were not significantly different (6.5 vs. 5.7).  She and her colleagues concluded that this laser procedure is safe and effective at relieving LUTS after failed previous BPH surgery.

“The holmium laser has been around since the late 1990s, but it is only used at a few institutions around the country,” Dr. Krambeck said. “I think part of the problem is that the learning curve is steep for this technique.

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