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Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis

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Abstract

Purpose

To study the safety, efficacy and trends in index procedures leading to salvage holmium laser enucleation of the prostate (S-HoLEP).

Methods

This was a single-institution retrospective review of HoLEPs performed between 2006 and 2020. Patients who underwent S-HoLEP were compared to those undergoing primary holmium laser enucleation of the prostate (P-HoLEP). The endpoint of primary interest were functional outcomes. Changes in index procedures over the study period were analyzed.

Results

A total of 633 HoLEPs were performed during the study, with 217 being S-HoLEP. The S-HoLEP cohort was older than P-HoLEP cohort, 71.2 years vs 68.8 years (p = 0.03). All other factors were well matched. The most common index procedures prior to S-HoLEP included transurethral resection of the prostate (TURP) (87, 40.1%), transurethral microwave thermotherapy (TUMT) (44, 20.3%), photoselective vaporization of the prostate (PVP) (24, 11.1%) and prostatic urethral lift (PUL) (24, 11.1%). Preoperative prostate volume, IPSS and Qmax were similar between groups. Intra-operatively, S-HoLEP had longer procedure and morcellation times (p = 0.01 and 0.007). Postoperatively, the S-HoLEP cohort had longer catheter duration and hospitalization (both p < 0.001). Postoperative Qmax, IPSS and 90-day complication rates were similar. On temporal analysis, minimally invasive surgical therapies (MIST) have become more prevalent as index procedures.

Conclusion

S-HoLEP is safe and efficacious for patients requiring additional BPH surgical intervention. S-HoLEP patients had longer operative times and hospital stays but equivalent postoperative functional outcomes compared to P-HoLEP. As MIST mature and gain traction, it is expected that rates of S-HoLEP will continue to rise.

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Funding

No funding was received to assist in preparation of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Adri M. Durant, Sandeep Voleti, Sarah Wu, Gopal Narang, Scott Cheney & Mitchell Humphreys

  2. Department of Urology, UC Davis, Davis, CA, USA

    Jonathan Moore

  3. Department of Quantitative Health Sciences, Scottsdale, AZ, USA

    Lanyu Mi

Authors
  1. Adri M. Durant
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  2. Jonathan Moore
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  3. Sandeep Voleti
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  4. Sarah Wu
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  5. Lanyu Mi
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  6. Gopal Narang
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  7. Scott Cheney
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  8. Mitchell Humphreys
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Contributions

AD was responsible for project development, data collection and manuscript writing/editing. JM was involved in project development, data collection and manuscript editing. SV and SW collected the data. LM carried out statistical analysis. GN took part in project development and edited the manuscript. SC and MH wrote/edited the manuscript.

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Correspondence to Adri M. Durant.

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Durant, A.M., Moore, J., Voleti, S. et al. Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis. World J Urol 40, 2305–2312 (2022). https://doi.org/10.1007/s00345-022-04098-w

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  • DOI: https://doi.org/10.1007/s00345-022-04098-w

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