Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Eur Urol Focus. 2021 Nov;7(6):1247-1253. doi: 10.1016/j.euf.2020.09.003. Epub 2020 Sep 19.
Although an increasing number of prostate cancer (PCa) patients received holmium laser enucleation of the prostate (HoLEP) previously for benign prostatic obstruction (BPO), there is still no evidence regarding the outcomes of radical prostatectomy (RP) in this setting.
To assess functional and oncological results of RP in PCa patients who received HoLEP for BPO previously in a contemporary multi-institutional cohort.
DESIGN, SETTING, AND PARTICIPANTS: A total of 95 patients who underwent RP between 2011 and 2019 and had a history of HoLEP were identified in two institutions. Functional as well as oncological follow-up was prospectively assessed and retrospectively analyzed.
RP following HoLEP compared with RP without previous transurethral surgery.
Patients with complete follow-up data were matched with individuals with no history of BPO surgery using propensity score matching. Complications were assessed using the Clavien-Dindo scale.
The median follow-up was 50.5 mo. We found no significant impact of previous HoLEP on positive surgical margin rate (14.0% [HoLEP] vs 18.8% [no HoLEP], p = 0.06) and biochemical recurrence-free survival (hazard ratio 0.74, 95% confidence interval [CI] 0.32-1.70, p = 0.4). Patients with a history of HoLEP had increased 1-yr urinary incontinence rates after RP. After adjusting for confounders, no significant impact of previous HoLEP was found (odds ratio [OR] 0.87, 95% CI 0.74-1.01; p = 0.07). Previous HoLEP did not hamper 1-yr erectile function recovery (OR 1.22, 95% CI 1.05-1.43; p = 0.01). Limitations include retrospective design and small sample size.
RP after previous HoLEP is surgically feasible, with low complication rates and no negative impact on biochemical recurrence-free survival. However, in a multivariable analysis, we observed significantly worse 1-yr continence rates in patients after previous HoLEP.
In the current study, we assessed the oncological and functional outcomes of radical prostatectomy in patients who underwent holmium laser enucleation of the prostate (HoLEP) previously due to prostatic bladder outlet obstruction. A history of HoLEP did not hamper oncological results, 1-yr continence, and erectile function recovery.
尽管越来越多的前列腺癌（PCa）患者先前因良性前列腺梗阻（BPO）接受了钬激光前列腺剜除术（HoLEP），但在此背景下，根治性前列腺切除术（RP）的结果仍缺乏证据。
在两个机构中，评估先前因 BPO 接受 HoLEP 治疗的 PCa 患者接受 RP 的功能和肿瘤学结果的一项当代多机构队列研究。
设计、设置和参与者：共在两个机构中确定了 95 名在 2011 年至 2019 年间接受 RP 且有 HoLEP 病史的患者。前瞻性评估了功能和肿瘤学随访情况，并进行了回顾性分析。
HoLEP 后的 RP 与无经尿道手术史的 RP 相比。
采用倾向评分匹配法，对具有完整随访数据的患者与无 BPO 手术史的患者进行匹配。采用 Clavien-Dindo 分级评估并发症。
中位随访时间为 50.5 个月。我们发现，先前的 HoLEP 对切缘阳性率（14.0% [HoLEP] 与 18.8% [无 HoLEP]，p=0.06）和生化无复发生存率（危险比 0.74，95%置信区间 [CI] 0.32-1.70，p=0.4）没有显著影响。有 HoLEP 病史的患者在接受 RP 后 1 年的尿失禁发生率增加。在调整混杂因素后，先前的 HoLEP 没有显著影响（比值比 [OR] 0.87，95% CI 0.74-1.01；p=0.07）。先前的 HoLEP 并没有妨碍 1 年的勃起功能恢复（OR 1.22，95% CI 1.05-1.43；p=0.01）。局限性包括回顾性设计和样本量小。
先前接受 HoLEP 治疗后行 RP 是可行的，具有较低的并发症发生率，并且不会对生化无复发生存率产生负面影响。然而，在多变量分析中，我们观察到先前接受 HoLEP 治疗的患者在 1 年时的控尿率显著下降。
在目前的研究中，我们评估了先前因前列腺膀胱出口梗阻接受钬激光前列腺剜除术（HoLEP）治疗的患者接受根治性前列腺切除术（RP）的肿瘤学和功能结果。HoLEP 病史不会影响肿瘤学结果、1 年控尿率和勃起功能恢复。
