title: Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting.
abstract: Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting.
  
  
  
  We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate.
  
  
  
  Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group.
  
  
  
  Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Tracy
authors.initials: T
authors.lastname: Marien
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kadihasanoglu
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Teerayut
authors.initials: T
authors.lastname: Tangpaitoon
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Nadya
authors.initials: N
authors.lastname: York
authors.affiliation: Mayo Clinic Minnesota, Rochester, Minnesota.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Blackburne
authors.affiliation: Mayo Clinic Arizona, Scottsdale, Arizona.
authors.forename: Haidar
authors.initials: H
authors.lastname: Abdul-Muhsin
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borofsky
authors.affiliation: Mayo Clinic Minnesota, Rochester, Minnesota.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.affiliation: Mayo Clinic Arizona, Scottsdale, Arizona.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: nicole.miller@vanderbilt.edu.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D019233:Retreatment; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods; D016896:Treatment Outcome
keywords: lasers; prostate; prostatic hyperplasia; salvage therapy; solid state; transurethral resection of prostate