Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting

Tracy Marien, Mustafa Kadihasanoglu, Teerayut Tangpaitoon, Nadya York, Andrew T. Blackburne, Haidar Abdul-Muhsin, Michael S. Borofsky, Amy E. Krambeck, Mitchell R. Humphreys, James E. Lingeman, Nicole L. Miller

Research output: Contribution to journalArticle

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Abstract

Purpose Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. Materials and Methods We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. Results Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group. Conclusions Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

Original languageEnglish (US)
Pages (from-to)1517-1522
Number of pages6
JournalJournal of Urology
Volume197
Issue number6
DOIs
StatePublished - Jun 1 2017

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Solid-State Lasers
Prostate
Therapeutics
Urethral Stricture
Prostatic Hyperplasia
Transurethral Resection of Prostate
Operative Time
Length of Stay
Demography
Weights and Measures

Keywords

  • lasers
  • prostate
  • prostatic hyperplasia
  • salvage therapy
  • solid state
  • transurethral resection of prostate

Cite this

Marien, T., Kadihasanoglu, M., Tangpaitoon, T., York, N., Blackburne, A. T., Abdul-Muhsin, H., ... Miller, N. L. (2017). Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting. Journal of Urology, 197(6), 1517-1522. https://doi.org/10.1016/j.juro.2016.12.098

Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting. / Marien, Tracy; Kadihasanoglu, Mustafa; Tangpaitoon, Teerayut; York, Nadya; Blackburne, Andrew T.; Abdul-Muhsin, Haidar; Borofsky, Michael S.; Krambeck, Amy E.; Humphreys, Mitchell R.; Lingeman, James E.; Miller, Nicole L.

In: Journal of Urology, Vol. 197, No. 6, 01.06.2017, p. 1517-1522.

Research output: Contribution to journalArticle

Marien, T, Kadihasanoglu, M, Tangpaitoon, T, York, N, Blackburne, AT, Abdul-Muhsin, H, Borofsky, MS, Krambeck, AE, Humphreys, MR, Lingeman, JE & Miller, NL 2017, 'Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting', Journal of Urology, vol. 197, no. 6, pp. 1517-1522. https://doi.org/10.1016/j.juro.2016.12.098
Marien T, Kadihasanoglu M, Tangpaitoon T, York N, Blackburne AT, Abdul-Muhsin H et al. Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting. Journal of Urology. 2017 Jun 1;197(6):1517-1522. https://doi.org/10.1016/j.juro.2016.12.098
Marien, Tracy ; Kadihasanoglu, Mustafa ; Tangpaitoon, Teerayut ; York, Nadya ; Blackburne, Andrew T. ; Abdul-Muhsin, Haidar ; Borofsky, Michael S. ; Krambeck, Amy E. ; Humphreys, Mitchell R. ; Lingeman, James E. ; Miller, Nicole L. / Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting. In: Journal of Urology. 2017 ; Vol. 197, No. 6. pp. 1517-1522.
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abstract = "Purpose Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. Materials and Methods We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. Results Of the 360 of 2,242 men (16{\%}) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71{\%}. The most common primary procedure was transurethral resection of the prostate in 42{\%} of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7{\%} vs 1.8{\%}, p = 0.01) and urethral stricture (3.3{\%} vs 1.5{\%}, p = 0.043) was slightly higher in the re-treatment group. Conclusions Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.",
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AU - Blackburne, Andrew T.

AU - Abdul-Muhsin, Haidar

AU - Borofsky, Michael S.

AU - Krambeck, Amy E.

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N2 - Purpose Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. Materials and Methods We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. Results Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group. Conclusions Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

AB - Purpose Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. Materials and Methods We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. Results Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group. Conclusions Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

KW - lasers

KW - prostate

KW - prostatic hyperplasia

KW - salvage therapy

KW - solid state

KW - transurethral resection of prostate

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