title: Holmium laser enucleation of the prostate for persistent lower urinary tract symptoms after prior benign prostatic hyperplasia surgery.
abstract: OBJECTIVE
  To evaluate comparative safety and outcomes in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery.
  
  
  METHODS
  We identified 37 patients who underwent HoLEP for persistent lower urinary tract symptoms (LUTS) after previous transurethral prostate surgery for benign prostatic hyperplasia (group I). Patients were then matched according to preoperative transrectal ultrasound prostate size to 74 patients without prior surgery who underwent HoLEP (group II). A retrospective chart review was performed.
  
  
  RESULTS
  In group I, no patients had previously undergone HoLEP, and 9 (24%) had undergone >1 surgery for benign prostatic hyperplasia (BPH). There were no significant differences in age, preoperative mean urinary flow, or preoperative prostate-specific antigen (PSA) value between groups I and II. There were no significant differences in perioperative parameters, including resected tissue weight (61.7 vs 63.9 grams, P = .83) or enucleation rate (1.32 vs 1.36 g/min, P = .76). There was no significant difference in mean catheterization time or length of hospital stay. Postoperative peak flow (23.4 vs 26.9 mL/sec, P = .14) and post-void residual (PVR, 50.9 vs 50.3 mL, P = .61) were improved and similar between groups. American Urological Association Symptom Indices (AUASIs) were improved in both groups, although the primary group was significantly lower (7.52 vs 5.21, P = .0060). There was no significant difference in adverse events. All patients were urinating at last follow-up (mean 18.4 and 15.1 months, P = .16).
  
  
  CONCLUSIONS
  HoLEP is safe and effective at relieving persistent LUTS after failed previous BPH surgery. Outcomes similar to those of a primary HoLEP procedure can be expected.
authors: The Department of Urology, Mayo Clinic School of Medicine, Rochester, MN 55905, USA.
authors: Christopher D
authors: CD
authors: Jaeger
authors: Amy E
authors: AE
authors: Krambeck
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000601:surgery*; D008297:Male; D011467:Prostate / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome