Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes

Gellhaus, Paul T.; Monn, M. Francesca; Leese, Joshua; Flack, Chandra K.; Lingeman, James E.; Koch, Michaël; Boris, Ronald S.

doi:10.1089/end.2014.0767

Cited by 25 publications

(12 citation statements)

References 20 publications

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“…RARP after HoLEP does not preclude improved oncological outcomes, or alleviating incontinence and erectile function. In addition, positive surgical margins, biochemical recurrence rates and perioperative complication rates resembled those in HoLEP-naive patients (Abedali, Calaway, Large, Koch, et al, 2020;Gellhaus et al, 2015;Kretschmer et al, 2020). RARP after HoLEP appears to be a safe surgical and oncological method in suitable patients.…”

Section: Discussionmentioning

confidence: 79%

“…Since most iPCas detected after HoLEP are low grade, patients can be expected to benefit from curative therapies. Fortunately, there are various treatment options such as active survelliance, or treatment with curative intent after HoLEP such as open or RARP, XRT and intensity-modulated radiation therapy (Bhojani et al, 2015;Gellhaus et al, 2015;Kretschmer et al, 2020;Rivera et al, 2014). Pentafecta is a concept that includes urinary continence, potency, cancer control, postoperative complications and negative surgical margins after RARP and that shows the functional and oncological results of surgery (Patel et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted by Gellhaus et al (2015), robot-assisted radical prostatectomy (RARP) after HoLEP proved feasible and promising in terms of oncological results. Besides curative treatments, Elkoushy et al reported that active surveillance is a rational option for lowgrade iPCa after HoLEP (Elkoushy et al, 2015).…”

Section: Managing Ipca After Holepmentioning

confidence: 99%

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Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

et al. 2021

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Lower urinary tract symptoms caused by benign prostatic obstruction (BPO) is one of the most common health problems in adult males (Gratzke et al., 2015). In the last decade, holmium laser enucleation of the prostate (HoLEP) has come to the fore in the surgical treatment of BPO as an alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP) in efficiency, safety and complication terms (

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

et al. 2021

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“…Second, some studies [18,19] that have been published suggest a longer mean time to UC recovery for patients with previous TURP. These patients who have received TURP before LRP usually have lower urinary tract symptoms (LUTS), especially di culty urinating.…”

Section: Discussionmentioning

confidence: 99%

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

Liu

Zhou

Song

et al. 2022

Preprint

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Purpose To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables. Methods We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from final rehabilitation reports after catheter extraction and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Eighteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP. Results After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate catheter removal, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction [odds ratio (OR) 1.77; 95% confidence interval (CI) 1.37–2.28; P < 0.001], and at 3 mo (OR 2.25; 95% CI 1.63–3.10; P < 0.001), 6 mo (OR 1.47; 95% CI 1.20–1.80; P < 0.001) and 12 mo (OR 1.50; 95% CI 1.11–2.04; P = 0.009) after surgery. Conclusion MUL is a significant independent factor that can contribute to recovery of short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment. .

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“…Other oncologic parameters like the positive margin and the biochemical recurrence rate were similar to patients without a previous history of BPH surgery. 63 In young patients with high PSA density and a negative standard template prostate biopsy that candidate for HoLEP, multiparametric MRI needs to be considered to exclude prostate cancer. This novel approach leads to low rates of incidental prostate cancer.…”

Section: Post-holep Urinary Incontinencementioning

confidence: 99%

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

et al. 2020

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Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

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Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes

Abstract: Post-HoLEP RARP is challenging but preliminarily appears safe and feasible when performed by an experienced robotic surgeon. Patients should be counseled regarding expectations of urinary continence and sexual function in this setting.

Cited by 25 publications

References 20 publications

Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

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