MP13-05 PREDICTORS OF REOPERATION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATE HYPERPLASIA

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2015MP13-05 PREDICTORS OF REOPERATION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATE HYPERPLASIA Mohamed Elkoushy, Ahmed Elshal, and Mostafa Elhilali Mohamed ElkoushyMohamed Elkoushy More articles by this author , Ahmed ElshalAhmed Elshal More articles by this author , and Mostafa ElhilaliMostafa Elhilali More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.345AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine factors predicting reoperation after Holmium laser enucleation of the prostate (HoLEP) for management of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) METHODS A prospectively maintained database was reviewed for patients undergoing HoLEP for symptomatic BPH. Baseline and follow-up data were compared in terms of International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), residual urine (PVR) and prostatic specific antigen (PSA) at 1, 6, and 12 months and then annually. Perioperative and late adverse events were recorded. Reoperation was defined as the need for any surgical intervention to relieve bothering LUTS after HoLEP. A multivariate logistic regression model was used to determine possible covariates associated with reoperation and a Kaplan-Meier curve assessed the time to reoperation. RESULTS A total of 1216 HoLEP procedures were operated between March 1998 and October 2013 with a mean prostate volume of 94.8±52.7cc. Catheter time and hospital stay were 1.4± 1.9 and 1.3 ± 1.6 days, respectively. After a mean follow-up of 7.3 years (1- 14 years), 52 (4.3%) patients needed reoperation for recurrent LUTS; 13 (1.07%) for recurrent adenoma, 14 (1.15%) for BNC and 25 (2.05%) for de novo urethral stricture. In multivariate regression, smaller prostate size and history of previous prostate surgery predicted recurrence of adenoma. BNC was significantly associated with smaller glands while longer operative time and postoperative catheterization were significantly associated with urethral stricture (Table 1). A Kaplan-Meier curve demonstrates freedom from post- HoLEP reoperation to be 96.9% at 5-years and 95.1% at 10- years (Figure1). CONCLUSIONS HoLEP has a long-term safety profile with low long-term complications, including reoperation rate. However, small-size prostate may have an impact on recurrence of adenoma and bladder neck contracture. Staged procedure should be considered for exceptionally long surgery. Table1. Factors affecting long-term complications after HoLEP Variable Residual/ recurrent adenoma (n= 13) Bladder neck contracture (n= 14) Urethral stricture (n= 25) Yes No p-value Yes No p-value yes No p-value Age at surgery (years) 68.4 ± 7.8 71.9 ± 8.1 0.10 67.2 ± 8.4 72.0 ± 8.0 0.02 72.6 ±7.6 71.9 ± 8.1 0.67 Preoperative catheter (n=452) 3 (20) 449 (37.4) 0.19 3 (21.4) 449 (37.4) 0.27 7 (28) 445 (37.4) 0.41 Previous prostate surgery (n=85) 5 (38.5) 80 (6.5) 0.001 2 (14.3) 83 (6.9) 0.26 2 (8.0) 83 (7.0) 0.69 Prostate volume (ml) 62.4 ± 21.7 94.6 ± 53.2 0.006 54.2 ± 37.7 94.6 ± 53 0.004 69.2 ± 35.8 95.4 ± 53.3 0.01 Concomitant procedure (n=117) 2 (13.3) 115 (9.6) 0.65 1 (7.1) 116 (9.6) 1.00 1 (4.0) 116 (9.7) 0.50 Operation time (min) 131 ±45 105 ± 48 0.037 98.3 ± 45.4 107.7 ± 57.7 0.54 124.3 ± 46.7 103.2 ± 57.7 0.028 Enucleation time (min) 102.3 ± 45.2 90.4 ± 52.3 0.12 87.6 ± 44.2 90.7 ± 52.4 0.81 74.6 ± 45.2 91.1 ± 74.6 0.24 Morcellation time (min) 19.8 ± 12.2 17.1 ± 15.1 0.04 11.7 ± 6.9 17.1 ± 15.2 0.24 11.7 ± 5.6 17.2 ± 15.3 0.07 Total energy used (kJ) 197.4 ± 110.5 187 ± 177.6 0.82 177.9 ± 103.7 187.2 ± 177.6 0.84 168.2 ± 117.3 187.5 ± 178 0.59 Catheterization time (day) 1.8 ± 1.6 1.4 ± 1.9 0.42 1.4 ± 1.9 1.2 ± 0.8 0.36 1.9 ± 1.2 1.2 ± 0.9 0.001 Data are reported as number (%) or mean ±SD © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e137-e138 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elkoushy More articles by this author Ahmed Elshal More articles by this author Mostafa Elhilali More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...