NEW ORLEANS, LA USA (UroToday.com) - In the management of benign prostate hyperplasia (BPH), important considerations include the factors that dictate the use of secondary interventions. Investigators sought to prospectively elucidate the factors that would have predictive significance in the need for reoperation after holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms (LUTS).
The authors set to retrospectively evaluate 1 216 men who underwent a HoLEP between 1998 and 2013 with a mean follow up of seven years. Baseline characteristics such as International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), residual urine (PVR), and prostatic specific antigen (PSA) were used. Statistical considerations were supplied by multivariate logistic regression models and survival curves to evaluate men who underwent reoperation (any surgical intervention to treat post-operative LUTS).
What the investigators discovered was after a median of 7.3 years a small reoperation rate of 4.3%. This small percentage reflected 52 patients composed of 13 (1.07%) requiring reoperation for various reasons: 13 (1.07%) for recurrent adenoma, 14 (1.15%) for bladder neck contracture (BNC), and 25 (2.05%) for de novo urethral stricture. Of interest, a smaller prostate volume was associated with reoperation rate due to regrown adenoma and BNC while longer operative time was associated with de novo urethral stricture. Average time to reoperation was highly associated with each specific reason for reoperation: early (20 months) procedures were seen with urethral strictures, followed by BNC at 72 months, and lastly recurrent adenoma at 80 months.
The authors’ results are validated by the current literature, as the reoperation rates reported are in a similar range to those concluded by the investigators. One of the limitations with the study was not enough follow up. Although the average follow-up time was seven years the authors reported a 10 year post HoLEP-free reoperation rate due to projections, not actual follow up. The investigators hope to gather more data to solidify their findings. Overall this study, reiterates the overall safety associated with HoLEP, substantiated by the less than 5% reoperation rate.
Presented by Ahmed Elshal at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
McGill University, Montreal, QC Canada
Reported by Blanca Morales (University of California-Irvine), medical writer for UroToday.com