Introduction & Objective :
Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for patients with benign prostatic hyperplasia (BPH). Reoperation rates are thought to be relatively low after initial HoLEP. The purpose of this study was to determine that long-term reoperation rates in patients after HoLEP.
A retrospective review, from an IRB approved database, of 632 patients that underwent a HoLEP at our institution between January 2010 and December 2017 was performed. Long-term reoperation was defined as patients who underwent initial HoLEP operation and then later on, a subsequent HoLEP or transurethral resection of the prostate (TURP) was required. Reoperation rates were analyzed at 1, 5, and 8 years post initial operation. All procedures were performed by a single-surgeon. Univariate analysis was performed for demographics and baseline characteristics.
A total of 30/632 (4.7%) patients who received initial HoLEP operation required reoperation. Of these patients, 93% (28/30) opted to undergo repeat HoLEP procedure and 7% (2/30) opted for transurethral resection of the prostate. One-year reoperation rate was 1.6%. Five-year reoperation rate was 2.9%. Eight-year reoperation rate was 4.7%. Average trans-rectal ultrasound (TRUS) prostate size for patients undergoing reoperations (± standard deviation) was 110.7 ± 56.2 grams. Mean prostatic gland volume on TRUS was 93.6 ± 56.6 grams for all patients. The average age and body mass index was 70.5 ± 8.5 years and 30 ± 11.9, respectively.
HoLEP is a safe and effective treatment for patients suffering from lower urinary tract symptoms. Long-term reoperation rates are relatively low. Prostate gland size may be associated with increased need for reoperation. Management and counseling should be directed towards a plan, especially in patients with larger prostate size.