Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate
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Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate. / Kretschmer, Alexander; Mazzone, Elio; Barletta, Francesco; Leni, Riccardo; Heidegger, Isabel; Tsaur, Igor; van den Bergh, Roderick C N; Valerio, Massimo; Marra, Giancarlo; Kasivisvanathan, Veeru; Buchner, Alexander; Stief, Christian G; Briganti, Alberto; Montorsi, Francesco; Tilki, Derya; Gandaglia, Giorgio; EAU-YAU Prostate Cancer Working Group.
In: EUR UROL FOCUS, Vol. 7, No. 6, 11.2021, p. 1247-1253.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate
AU - Kretschmer, Alexander
AU - Mazzone, Elio
AU - Barletta, Francesco
AU - Leni, Riccardo
AU - Heidegger, Isabel
AU - Tsaur, Igor
AU - van den Bergh, Roderick C N
AU - Valerio, Massimo
AU - Marra, Giancarlo
AU - Kasivisvanathan, Veeru
AU - Buchner, Alexander
AU - Stief, Christian G
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Tilki, Derya
AU - Gandaglia, Giorgio
AU - EAU-YAU Prostate Cancer Working Group
N1 - Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
U2 - 10.1016/j.euf.2020.09.003
DO - 10.1016/j.euf.2020.09.003
M3 - SCORING: Journal article
C2 - 32962962
VL - 7
SP - 1247
EP - 1253
JO - EUR UROL FOCUS
JF - EUR UROL FOCUS
SN - 2405-4569
IS - 6
ER -