Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

Abstract

Introduction:We determine the impact of prostate size on the long-term outcome of holmium laser transurethral incision of the prostate (Ho-TUIP) for bladder outlet obstruction (BOO) secondary to benign prostate enlargement (BPE). Methods: A retrospective review of prospectively collected data was performed for patients undergoing Ho-TUIP by a single surgeon for patients presenting with lower urinary tract symptoms (LUTS) secondary to BOO. Patients were stratified into 2 groups: Group 1 included patients with prostate ≤30 cc and Group 2 included patients with prostate >30 cc. Demographic, operative and followup data were recorded and analyzed. In addition, intraoperative and long-term adverse events were included. Results: In total, 82 patients underwent surgery between March 1998 and March 2013, including 9 (11%) reoperated patients. Only prostate size independently predicted reoperation after Ho-TUIP (adjusted odds ratio [aOR], 95% confidence interval [CI] 7.12 [2.92-9.14], p = 0.01). The receiver operating characteristic (ROC) analysis showed an optimal cutoff value of prostate volume of 29 cc to characterize long-term reoperation after TUIP, with area under the curve (AUC) of 0.96, sensitivity of 89.7 and specificity of 88.9. Group 1 included 51 patients and Group 2 included 31 patients. The international prostate symptoms score (IPSS) and peak flow rate (Qmax) significantly improved in both groups at different follow-up points. At the 12-month follow-up, the percent change in IPSS and Qmax were comparable between both groups. However, after 12 months, the degree of improvement in all voiding parameters was significantly higher in Group 1 (p < 0.001 at all points of follow-up). After a median follow-up of 5.3 years (range: 1-13), both groups had comparable early and late adverse events with significantly higher reoperation rate in Group 2 (3.9% vs. 22.6%, p = 0.02). Overall retrograde ejaculation was detected in 25.6% of sexually active men and it was comparable between both groups (23.5% vs. 29%, p = 0.61). On multivariable analysis, patients with prostate volume >30 cc were associated with significantly higher reoperation for BOO (aOR 95% CI 5.72 [2.83-8.14], p = 0.02), significantly higher IPSS (aOR 1.72), higher quality of life index (aOR 1.72) and lower Qmax (aOR 0.28). Conclusion: Ho-TUIP is a durable, safe and efficient treatment of BOO secondary to a small-sized prostate. The long-term outcome could be improved and the re-operation rate could be minimized with appropriate selection of cases, with prostate glands no bigger than 30 cc.

Let’s not forget about TUIP: A highly underutilized, minimally invasive and durable technique for men with <30 g prostates

“…7,8 In the current retrospective study of 80 patients, Elkoushy and colleagues demonstrate a durability of benefits with long-term 5-year follow-up in prostate volumes <30 cc. 9 Interestingly, re-operated patients (11%) after Ho-TUIP had significantly larger prostate volume (36.8 ± 8.9 vs. 27.6 ± 5.1 cc, p < 0.001). Furthermore, the authors showed in a multivariate regression model that only prostate size independently predicted re-operation (adjusted odds ratio 95% confidence interval 7.12 [2.92-9.14], p = 0.01).…”

Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

“…25 Short-and long-term functional outcomes of these different procedures have been previously published, including 3 randomized controlled trials comparing the 3 generations of the 532-nm laser with holmium laser ablation and enucleation. [26][27][28][29][30][31][32] In our current study, all 3 successive groups were comparable regarding long-term adverse events and reoperation rates. However, there was a progressive decrease in the incidence of urethral stricture over time.…”

Ejaculation Sparing Bladder Neck Incision with Holmium Laser in Patients with Urinary Symptoms and Small Prostates: Short-Term Functional Results

“…The vaporization of prostatic tissue induced by the use of holmium laser could be however the main culprit for the high rate of retrograde ejaculation, which is reported to be around 25-27% [5,6].…”

“…Its main limitation is however a relatively high rate of retrograde ejaculation, which may affect up to 27% of younger men undergoing this procedure [5,6]. As showed in same epidemiological studies, absence of ejaculation affects sexual activity and global quality of life (QoL) [7,8].…”