HoLEP Safe, Effective After Failed BPH Surgery

Holmium laser enucleation of the prostate (HoLEP) is safe and effective for easing persistent lower urinary tract symptoms after failed prior surgery for benign prostatic hyperplasia (BPH), researchers concluded.

Investigators at Mayo Clinic in Rochester, Minn., led by Amy E. Krambeck, MD, identified 37 patients who underwent HoLEP for persistent lower urinary tract symptoms (LUTS) after having had previous transurethral prostate surgery for benign prostatic hyperplasia (group I). These patients were matched according to preoperative prostate size to 74 patients who underwent HoLEP but did not have prior surgery (group II).

Results showed that both groups had significant and similar improvements in peak flow rate and post-void residual (PVR). The mean peak flow rate rose from 10.4 at baseline to 23.4 mL/sec postoperatively in group I and from 7.5 to 26.9 mL/sec in group II, Dr. Krambeck's group reported online ahead of print in Urology. The PVR decreased from 200 to 50.9 mL in group I and from 311 to 50.3 mL in group II.

The mean American Urological Association Symptom Index (AUASI) scores were improved in both groups, but group II had a significantly lower score.

The two groups were similar with respect to resected tissue weight and enucleation time as well as adverse event rates, the investigators noted. All patients were urinating at last follow-up (mean 18.4 and 15.1 months, a non-significant difference).

“Our study demonstrates similar efficacy and incidence of complications regardless of prior transurethral prostate surgery, and a history of surgery should not preclude using HoLEP for recurrent LUTS associated with adenomatous regrowth,” the study authors concluded.

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