Journal article
Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate.
- Kretschmer A Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany. Electronic address: Alexander.kretschmer@med.uni-muenchen.de.
- Mazzone E Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Barletta F Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Leni R Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Heidegger I Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
- Tsaur I Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany.
- van den Bergh RCN Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands.
- Valerio M Department of Urology, CHUV, Lausanne, Switzerland.
- Marra G Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
- Kasivisvanathan V Division of Surgery and Interventional Science, University College London, London, UK.
- Buchner A Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
- Stief CG Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
- Briganti A Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Montorsi F Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Tilki D Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany.
- Gandaglia G Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- 2020-09-23
Published in:
- European urology focus. - 2020
Holmium laser enucleation of the prostate
Localized prostate cancer
Patient-reported outcomes
Radical prostatectomy
Urinary continence
English
BACKGROUND
Although an increasing number of prostate cancer (PCa) patients received holmium laser enucleation of the prostate (HoLEP) previously for benign prostatic obstruction (BPO), there is still no evidence regarding the outcomes of radical prostatectomy (RP) in this setting.
OBJECTIVE
To assess functional and oncological results of RP in PCa patients who received HoLEP for BPO previously in a contemporary multi-institutional cohort.
DESIGN, SETTING, AND PARTICIPANTS
A total of 95 patients who underwent RP between 2011 and 2019 and had a history of HoLEP were identified in two institutions. Functional as well as oncological follow-up was prospectively assessed and retrospectively analyzed.
INTERVENTION
RP following HoLEP compared with RP without previous transurethral surgery.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Patients with complete follow-up data were matched with individuals with no history of BPO surgery using propensity score matching. Complications were assessed using the Clavien-Dindo scale.
RESULTS AND LIMITATIONS
The median follow-up was 50.5 mo. We found no significant impact of previous HoLEP on positive surgical margin rate (14.0% [HoLEP] vs 18.8% [no HoLEP], p = 0.06) and biochemical recurrence-free survival (hazard ratio 0.74, 95% confidence interval [CI] 0.32-1.70, p = 0.4). Patients with a history of HoLEP had increased 1-yr urinary incontinence rates after RP. After adjusting for confounders, no significant impact of previous HoLEP was found (odds ratio [OR] 0.87, 95% CI 0.74-1.01; p = 0.07). Previous HoLEP did not hamper 1-yr erectile function recovery (OR 1.22, 95% CI 1.05-1.43; p = 0.01). Limitations include retrospective design and small sample size.
CONCLUSIONS
RP after previous HoLEP is surgically feasible, with low complication rates and no negative impact on biochemical recurrence-free survival. However, in a multivariable analysis, we observed significantly worse 1-yr continence rates in patients after previous HoLEP.
PATIENT SUMMARY
In the current study, we assessed the oncological and functional outcomes of radical prostatectomy in patients who underwent holmium laser enucleation of the prostate (HoLEP) previously due to prostatic bladder outlet obstruction. A history of HoLEP did not hamper oncological results, 1-yr continence, and erectile function recovery.
Although an increasing number of prostate cancer (PCa) patients received holmium laser enucleation of the prostate (HoLEP) previously for benign prostatic obstruction (BPO), there is still no evidence regarding the outcomes of radical prostatectomy (RP) in this setting.
OBJECTIVE
To assess functional and oncological results of RP in PCa patients who received HoLEP for BPO previously in a contemporary multi-institutional cohort.
DESIGN, SETTING, AND PARTICIPANTS
A total of 95 patients who underwent RP between 2011 and 2019 and had a history of HoLEP were identified in two institutions. Functional as well as oncological follow-up was prospectively assessed and retrospectively analyzed.
INTERVENTION
RP following HoLEP compared with RP without previous transurethral surgery.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Patients with complete follow-up data were matched with individuals with no history of BPO surgery using propensity score matching. Complications were assessed using the Clavien-Dindo scale.
RESULTS AND LIMITATIONS
The median follow-up was 50.5 mo. We found no significant impact of previous HoLEP on positive surgical margin rate (14.0% [HoLEP] vs 18.8% [no HoLEP], p = 0.06) and biochemical recurrence-free survival (hazard ratio 0.74, 95% confidence interval [CI] 0.32-1.70, p = 0.4). Patients with a history of HoLEP had increased 1-yr urinary incontinence rates after RP. After adjusting for confounders, no significant impact of previous HoLEP was found (odds ratio [OR] 0.87, 95% CI 0.74-1.01; p = 0.07). Previous HoLEP did not hamper 1-yr erectile function recovery (OR 1.22, 95% CI 1.05-1.43; p = 0.01). Limitations include retrospective design and small sample size.
CONCLUSIONS
RP after previous HoLEP is surgically feasible, with low complication rates and no negative impact on biochemical recurrence-free survival. However, in a multivariable analysis, we observed significantly worse 1-yr continence rates in patients after previous HoLEP.
PATIENT SUMMARY
In the current study, we assessed the oncological and functional outcomes of radical prostatectomy in patients who underwent holmium laser enucleation of the prostate (HoLEP) previously due to prostatic bladder outlet obstruction. A history of HoLEP did not hamper oncological results, 1-yr continence, and erectile function recovery.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.euf.2020.09.003
- PMID 32962962
- Persistent URL
- https://folia.unifr.ch/global/documents/239546
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