MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON Francesco Montorsi, Paolo Capogrosso, Giuseppe Fallara, Eugenio Ventimiglia, Edoardo Pozzi, Federico Belladelli, Luigi Candela, Francesco Pellegrino, Federico Dehò, Andrea Salonia, and Alberto Briganti Francesco MontorsiFrancesco Montorsi More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Federico DehòFederico Dehò More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure. However, whether long surgical experience is able to improve peri- and post-operative outcomes is still unknown. We thus investigated results and complications after HoLEP performed by a highly experienced surgeon. METHODS: This is a single-institutional prospective study (NCT03583034) performed at a tertiary referral centre including 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single highly experienced surgeon (>1600 cases performed). Patients were assessed using validated questionnaires, PSA measurements and uroflowmetry at baseline and several follow-up dates. Intra- and postoperative complications were recorded and graded according to Clavien-Dindo (CD) classification. The Kaplan-Meier analysis estimated urinary continence (UC) (defined as no pad) and erectile function (EF) recovery rates. Logistic regression models assessed predictors of post-operative complications. RESULTS: Median (IQR) prostate volume (PV) was 87cc (60-115) with 146 (59.8%) patients having a PV>80 cc and 78 (32.1%) having an indwelling catheter at baseline. At 3-month follow-up, 219 (90.1%) patients had a peak flow rate >20 ml/s, and 182 (74.9%) had a null residual urine volume. Improvement in subjective symptoms as assessed with the IPSS was significant already at 1-month, and it was maintained until 12-month after surgery. UC recovery was slow with estimated rates of 68% (62-74%) at 1-month and 94% (91-97%) at 12-month post-HoLEP. Increased PV (HR 0.95; 95% CI: 0.91-0.99), incontinence at baseline (HR 0.45; 95% CI: 0.27-0.73) and a higher baseline IPSS (HR 0.97; 95% CI: 0.94-0.99) were predictors of worse UC recovery rates (all p<0.04). The EF recovery rates were 53% (46-61%) at 1-month and 85% (77-90%) at 12-month post-HoLEP. Post-operative complications were reported in 36 (14.8%) patients during hospital stay [CD-2: 14 (5.8%); CD-3: 1 (0.4%)], in 34 (14%) within one month post-discharge [CD-2: 17 (6.9%); CD-3: 1 (0.4%)] and in 10 (4.1%) at later follow-up [CD-2: 3 (1.2%); CD-3: 6 (2.4%)]. Severe complications (CD≥2) were more common in patients with indwelling catheter at baseline (OR: 5.05; p=0.006). CONCLUSIONS: A highly experienced surgeon is commonly referred complex cases of LUTS due to BPE. Although HoLEP remains an effective procedure, it is not devoid of complications and sequelae even in the hands of a surgeon with more than 1600 procedures completed. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e179 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Montorsi More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Eugenio Ventimiglia More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Luigi Candela More articles by this author Francesco Pellegrino More articles by this author Federico Dehò More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...