Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate

Background: Scarce data are available about long-term follow-up (FU) in men undergoing holmium laser enucleation of the prostate (HoLEP). Objective: To investigate the risk of being symptomatic at 10-yr FU after HoLEP. Design, setting, and participants: Perioperative data from 125 patients submitted to HoLEP in 2007-2010 by a single, highly experienced surgeon were analyzed. Patients were assessed by International Prostate Symptoms Score (IPSS), prostate-specific antigen (PSA), and uroflowmetry at 6-mo and 10-yr FU. Outcome measurements and statistical analysis: Logistic regression models tested the association between clinically significant predictors and the risk of being symptomatic at long-term FU (defined as IPSS > 8 and/or peak flow rate [PFR] < 15 ml/s and/or postvoid residual volume [PVR] > 20 ml, need for symptomatic medical treatment, or redo surgery). Results and limitations: At surgery, median (interquartile range) age was 66 years (61, 69), prostate volume was 78 ml (56, 105), and PFR was 9 ml/s (7, 12). All patients showed favorable outcomes (ie, IPSS and uroflowmetry parameters) 6 months after surgery. At median 126-month FU, PFR was 16 ml/s (13, 23), PVR was 10 ml (5, 15), total IPSS was 5 (1- 7), and PSA was 0.7 ng/ml (0.4,1.3). Of all, 32 patients (26%) were symptomatic at long-term FU, seven (5.7%) reported urinary incontinence, and six (4.7%) underwent redo surgery throughout the FU period due to either bladder neck contracture or urethral stricture. Older patients at surgery (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.03-1.22; p = 0.006) and patients who never recovered full continence postoperatively (OR: 0.49; 95% CI: 0.01-0.27; p = 0.001) were at a higher risk of being symptomatic at very long-term FU, after adjusting for baseline clinical characteristics. Conclusions: HoLEP ensures a durable relief of urinary symptoms in almost 75% of patients up to 10 years after surgery. Older patients and those who do not recover from inconti-nence after surgery should be counseled carefully regarding a higher risk of symptom recurrence at long-term assessment. Patient summary: Consistent symptom relief is preserved even 10 years after holmium laser enucleation of the prostate in almost 75% of patients. Older age and incomplete continence recovery after surgery were the two most relevant risk factors for being symptomatic at long-term follow-up. Postoperative functional outcomes are kept in three out of four patients at 10-yr follow-up after holmium laser enucleation of the prostate. Conversely, the older the patient at surgery and the presence of incomplete continence recovery throughout the postoperative period, the greater the probability of being symptomatic at long-term follow-up. (c) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Automated summary

A retrospective analysis of 125 patients undergoing HoLEP found favorable outcomes at 6 months and 10 years postoperatively, with almost 75% of patients still experiencing symptom relief after a decade. Older age at surgery and incomplete recovery from incontinence postoperatively were identified as major predictors for symptomatic recurrence at long-term follow-up.