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RESULTS: The majority of the 360 (16%) men undergoing rHoLEP did so for residual urinary symptoms (71%). The most commonly primary procedure was transurethral resection of the prostate (42%). Mean time between prior BPH surgery and rHoLEP was 68 months (1-444 months). There were no significant differences in age, prostate size, AUA symptom score (AUASS), or average flow rate between cohorts. Perioperatively, rHoLEP was associated with significantly shorter operative times, reduced blood loss, lower specimen weight, and shorter length of stay. AUASS improved in both groups, though remained higher for men undergoing rHoLEP (6.5 versus 5.0, P < 0.001).Likelihood of clot retention (4.7% versus 1.8%, P = 0.01) and urethral stricture (3.3% versus 1.5%, P = 0.043) were slightly higher in the rHoLEP group. CONCLUSIONS: Immediate perioperative outcomes for HoLEP performed in the retreatment setting are no different from those in the primary setting. While rHoLEP was associated with increases in likelihood of clot retention, urethral stricture, and AUA

Bulking agents have low long-term efficacy and carry the risk of fistula formation. The efficacy of tension-free sling placement is low and continence requires an obstructing sling. Counseling should include acceptance of multiple procedures, which may be necessary to achieve continence, and consideration of conduit diversion.

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theoretical risk of fluid overload especially in patients with cardiac risk. Larger studies are needed to confirm these findings.