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Peripheral zone thickness in preoperative MRI is predictive of Trifecta achievement after Holmium laser enucleation of the prostate (HoLEP).

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate various anatomical features of the prostate using preoperative MRI and patients’ clinical factors to identify predictors of successful Holmium:YAG laser enucleation of the prostate (HoLEP).

Methods

71 patients who had received HoLEP and undergone a 3.0-T prostate MRI scan within 6 months before surgery were retrospectively enrolled. MRI features (e.g., total prostate and transitional zone volume, peripheral zone thickness [PZT], BPH patterns, prostatic urethral angle, intravesical prostatic protrusion, etc.) and clinical data (e.g., age, body mass index, surgical technique, etc.) were analyzed using univariable and multivariable logistic regression to identify predictors of successful HoLEP. Successful HoLEP was defined as achieving the Trifecta, characterized by the contemporary absence of postoperative complications within 3 months, a 3-month postoperative maximum flow rate (Qmax) > 15 mL/s, and no urinary incontinence at 3 months postoperatively.

Results

Trifecta achievement at 3 months post-surgery was observed in 37 (52%) patients. Patients with Trifecta achievement exhibited a lower preoperative IPSS-quality of life score (QoL) (4.1 vs. 4.5, P = 0.016) and a thinner preoperative peripheral zone thickness (PZT) on MRI (7.9 vs.10.3 mm, P < 0.001). In the multivariable regression analysis, a preoperative IPSS-QoL score < 5 (OR 3.98; 95% CI, 1.21–13.07; P = 0.017) and PZT < 9 mm (OR 11.51; 95% CI, 3.51–37.74; P < 0.001) were significant predictors of Trifecta achievement after HoLEP.

Conclusions

Alongside the preoperative QoL score, PZT measurement in prostate MRI can serve as an objective predictor of successful HoLEP. Our results underscore an additional utility of prostate MRI beyond its role in excluding concurrent prostate cancer.

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Code availability

The datasets and codes used in this study are available from the corresponding author on reasonable request.

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Acknowledgements

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The authors did not receive support from any organization for the submitted work.

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Author notes

  1. Jae Hyon Park and Jongjin Yoon contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Armed Forces Daejeon Hospital, Daejeon, Korea

    Jae Hyon Park

  2. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Jongjin Yoon, Jun Gu Kang, Dae Chul Jung, Byung-Chul Kang & Young Taik Oh

  3. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Insun Park

  4. Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea

    Jongsoo Lee & Jang Hwan Kim

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by J.H.P. and J.Y. The first draft of the manuscript was written by J.H.P., J.Y., and I.P. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Young Taik Oh.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board of Severance Hospital (IRB No. 2023-2003-001).

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Written informed consent was waived due to the retrospective nature of the study.

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Park, J.H., Yoon, J., Park, I. et al. Peripheral zone thickness in preoperative MRI is predictive of Trifecta achievement after Holmium laser enucleation of the prostate (HoLEP).. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04233-8

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