Abstract
Background
Anatomical endoscopic enucleation of the prostate (AEEP) is recommended for first line surgical treatment of benign prostatic obstruction (BPO) caused by moderate and large prostatic adenoma. However, its role in the retreatment setting after failed previous surgical treatment for BPO remains uncaptured. In this scope, we performed a systematic review and meta-analysis aiming to assess the safety and efficacy of AEEP in the retreatment setting.
Methods
We searched PubMed, Cochrane Library and Embase databases from inception to March 2022 for prospective or retrospective studies involving patients undergoing prostatic enucleation for recurrent or residual BPO after previous standard or minimally invasive surgical treatments for BPO. Based on data availability, we performed a meta-analysis comparing AEEP in patients with recurrent or residual BPO versus AEEP for primary BPO. PROSPERO: CRD42022308941).
Results
We included 15 studies in the systematic review and 10 in the meta-analysis (6553 patients, 841 with recurrent or residual BPO and 5712 with primary BPO). All included studies involved patients undergoing HoLEP or ThuLEP. In terms of Qmax, post-void residual, International Prostate Symptom Score, removed adenoma, operative time, duration of catheterization and hospital stay, as well as complications, HoLEP for recurrent or residual BPO was equally effective compared to HoLEP for primary BPO up to 1 year postoperatively. Importantly, the beneficial effect of HoLEP on the retreatment setting was observed after previous standard or minimally invasive surgical treatments for BPO. The overall strength of evidence for all outcomes was deemed very low.
Conclusions
HoLEP may be safely and effectively used in experienced hands for the surgical treatment of recurrent or residual BPO in patients with large or moderate prostates following previous open, endoscopic or minimally invasive surgical treatment for BPO.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in america project: benign prostatic hyperplasia. J Urol. 2005;173:1256–61.
Morton A, Williams M, Perera M, Teloken PE, Donato P, Ranasinghe S, et al. Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data. BJU Int. 2020;126:18–26.
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015;67:1099–109.
Wasson JH, Bubolz TA, Lu-Yao GL, Walker-Corkery E, Hammond CS, Barry MJ. Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997. For the Patient Outcomes Research Team for Prostatic Diseases. J Urol. 2000;164:1212–5.
Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N. Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital. J Endourol. 2012;26:878–83.
Madersbacher S, Lackner J, Brössner C, Röhlich M, Stancik I, Willinger M, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005;47:499–504.
Vesely S, Knutson T, Dicuio M, Damber J-E, Dahlstrand C. Transurethral microwave thermotherapy: clinical results after 11 years of use. J Endourol. 2005;19:730–3.
Welk B, Reid J, Ordon M, Razvi H, Campbell J. Population-based assessment of re-treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate. BJU Int. 2019;124:1047–54.
Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II-Surgical Evaluation and Treatment. J Urol. 2021;206:818–26.
Huang S-W, Tsai C-Y, Tseng C-S, Shih M-C, Yeh Y-C, Chien K-L, et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ. 2019;367:15919.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al. (editors). Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons; 2019.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Online). 2016;355:i4919. https://doi.org/10.1136/bmj.i4919.
Han JL, Gandhi S, Bockoven CG, Narayan VM, Dahm P. The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality. BJU Int. 2017;119:638–49.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327:557–60.
Becker B, Netsch C, Glybochko P, Rapoport L, Taratkin M. A Feasibility Study Utilizing the Thulium and Holmium Laser in Patients for the Treatment of Recurrent Benign Prostatic Hyperplasia after Previous Prostatic Surgery. Urologia Internationalis. 2018;101:212–8.
Das A, Han TM, Rudnick B, Hardacker T, Shenot PJ. Holmium Laser Enucleation of the Prostate Following Previous Prostatic Urethral Lift. J Endourol. 2022;36:111–6.
Elshal AM, Elmansy HM, Elhilali MM. Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH). BJU Int. 2012;110:E845–50.
Gnessin E, Miller NL, Handa SE. Holmium laser enucleation of the prostate (HoLEP) as re-treatment following prior BPH intervention. J Endourol. 2010;24:A207–A207.
Jaeger CD, Krambeck AE. Holmium laser enucleation of the prostate for persistent lower urinary tract symptoms after prior benign prostatic hyperplasia surgery. Urology. 2013;81:1025–9.
Knoedler M, Manakas C, Eifler A. Efficient holmium laser enucleation of the prostate can be performed after prostatic artery Embolization for massive prostate glands (> 250 Grams). J Endourol. 2021;35:A160–A161.
Li P, Wang C, Cao Q, Zhang J, Shi H, Meng X, et al. Prostatic Arterial Embolization Followed by Holmium Laser Enucleation of the Prostate as a Planned Combined Approach for Extremely Enlarged Benign Prostate Hyperplasia. Urologia Internationalis. 2017;99:422–8.
Marien T, Kadihasanoglu M, Tangpaitoon T, York N, Blackburne AT, Abdul-Muhsin H, et al. Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting. J Urol. 2017;197:1517–22.
McAdams S, Funk JT, Navetta AF, El Tayeb MM, Humphreys MR. Holmium Laser Enucleation of the Prostate after Prostatic Urethral Lift Surgery: Feasibility and Technical Considerations from a Multi-Institutional Case Series. J Endourol. 2017;31:774–9.
Oh JK, Bae J, Jeong CW, Paick J-S, Oh S-J. Salvage Holmium laser enucleation of prostate to treat residual benign prostatic hyperplasia. Can Urological Assoc J = J de l’Assoc des Urologues du Can. 2014;8:E235–40.
Parmar M, Katz JE, Blachman-Braun R, Smith NA, Oneto SM, Bhatia S, et al. Safety and efficacy of holmium laser enucleation of prostate as salvage procedure for persistent or recurrent lower urinary tract symptoms secondary to bladder outlet obstruction after prior prostate artery embolization: a match analysis. World J Urol. 2021;39:4199–206.
Pickens R, Krambeck A, Humphreys M. Holmium laser enucleation of the prostate (HOLEP) outcomes in patients with prior benign prostatic hypertrophy (BPH) surgery. J Endourol. 2013;27:A68–A68.
Shah H, Shah R HS. Prospective study comparing safety and efficacy of HoLEP for recurrent BPH after initial TURP. J Urol. 2017;197:e329–e330.
Sharma A. It’s not harder the second time around!!! HoLEP for persistent bladder outlet obstruction after TURP. BJU Int. 2016;117:20–1.
Warner JN, Nunez R, Martin GL, Nakamura LY. Evaluation of functional outcomes after holep on patients status post prior surgical therapy for BPH. J Endourol. 2010;24:A206–A206.
Gupta AK, Gupta S, Pradhan P, Gite R. Efficacy of tamsulosin in persistent obstructive voiding symptoms after transurethral surgery of prostate: a double blind placebo-controlled prospective study. Indian J Urol. 2016;32(Suppl 1):S38–S165.
Gilfrich C, May M, Fahlenbrach C, Günster C, Jeschke E, Popken G, et al. Surgical Reintervention Rates after Invasive Treatment for Lower Urinary Tract Symptoms due to Benign Prostatic Syndrome: A Comparative Study of More than 43,000 Patients with Long-Term Followup. J Urol. 2021;205:855–63.
Chen W, Goh N. Recurrent prostate adenoma: Clinical presentations and management. BJU Int. 2014;113:14.
Zhang Y, Yuan P, Ma D, Gao X, Wei C, Liu Z, et al. Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis. 2019;22:493–508.
Ibrahim A, Alharbi M, Elhilali MM, Aubé M, Carrier S. 18 Years of Holmium Laser Enucleation of the Prostate: A Single Center Experience. J Urol. 2019;202:795–800.
Haraguchi T, Takenaka A, Yamazaki T, Nakano Y, Miyake H, Tanaka K, et al. The relationship between the reproducibility of holmium laser enucleation of the prostate and prostate size over the learning curve. Prostate Cancer Prostatic Dis. 2009;12:281–4.
Placer J, Gelabert-Mas A, Vallmanya F, Manresa JM, Menéndez V, Cortadellas R, et al. Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. Urology. 2009;73:1042–8.
Elkoushy MA, Elshal AM, Elhilali MM. Reoperation After Holmium Laser Enucleation of the Prostate for Management of Benign Prostatic Hyperplasia: Assessment of Risk Factors with Time to Event Analysis. J Endourol. 2015;29:797–804.
Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2013;189:S141–145.
Bhat A, Blachman-Braun R, Herrmann TRW, Shah HN. Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction. World J Urol. 2022;40:889–905.
Xu Z-W, Tian W, Zhou C-G, Leng B, Shi H-B, Liu S. Prostatic Artery Embolization for the Treatment of Recurrent Lower Urinary Tract Symptoms following Transurethral Resection of the Prostate. J Vasc Interven Radiol. 2021;32:242–6.
Te AE, Cho A, Chughtai BI. How I Handle Retreatment of LUTS Following a Failed MIST. Curr Urol Rep. 2021;22:40.
Wong C, Spaliviero M, Strom K. Greenlight hpsTM laser Photoselective Vaporization Prostatectomy (PVP) for failed prior surgical treatment of Benign Prostatic Hyperplasia (BPH). Urology. 2009;74:S313.
Author information
Authors and Affiliations
Contributions
All authors participated in the drafting, writing, and editing of the paper.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Pyrgidis, N., Mykoniatis, I., Lusuardi, L. et al. Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis. Prostate Cancer Prostatic Dis 26, 693–701 (2023). https://doi.org/10.1038/s41391-023-00677-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41391-023-00677-z
This article is cited by
-
Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer
Prostate Cancer and Prostatic Diseases (2024)