Artiles Medina Alberto, Tagalos Muñoz Ana, Domínguez Gutiérrez Ana, Muriel García Alfonso, Subiela José Daniel, Álvarez Díaz Noelia, Fernández Conejo Guillermo, Gómez Dos Santos Victoria, Coloma Del Peso Almudena, Burgos Revilla Francisco Javier
Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain.
Eur Urol Open Sci. 2025 Aug 11;79:111-127. doi: 10.1016/j.euros.2025.07.011. eCollection 2025 Sep.
Holmium laser enucleation of the prostate (HoLEP) is a common surgical management option for localised prostate cancer (PCa). This review aims to ascertain the safety, and functional and pathological outcomes of active treatments (radical prostatectomy [RP], radiotherapy [RT], and focal therapy) for localised PCa after HoLEP.
A systematic review and meta-analysis (PROSPERO registration: CRD42024562687) was conducted, searching the Ovid (Medline) and Embase (Elsevier) databases until October 2024. Comparative and noncomparative studies providing data on patients who underwent HoLEP and subsequent treatment modalities for PCa were included if these reported post- or intraoperative complications, pathological findings, and oncological or functional outcomes.
Of the 1567 studies identified, 22 were included. Patients with a history of HoLEP who had undergone RP did not have significantly worse erectile function rates or pathological outcomes than those without prior surgery for benign prostatic hyperplasia. However, HoLEP patients had higher intraoperative complication (odds ratio [OR] 10.78 [95% confidence interval {CI} 2.98-39.03]) and urethrovesical anastomosis leakage (OR 7.15 [95% CI 1.83-27.89]) rates, as well as lower urinary continence rates (OR 0.44, 95% CI 0.30-0.67). Continence rate was lower with RP than with RT (OR 0.15 [95% CI 0.05-0.42]). Limitations were scarcity of relevant studies (especially for treatments other than RP), their predominantly observational and retrospective nature, and their small sample sizes.
The findings from this meta-analysis should be considered for patient counselling and management decisions, bearing in mind that patients with prior HoLEP who undergo RP have more intraoperative complications and urethrovesical anastomotic leaks and an increased postoperative incontinence rate. Our findings also highlight the need for further prospective comparative research to evaluate the oncological outcomes of these interventions.
We investigated the outcomes in patients treated for localised prostate cancer following previous holmium laser enucleation of the prostate (HoLEP). We found that patients treated with radical prostatectomy after HoLEP have favourable pathological and erectile function outcomes. Intraoperative complication and urinary incontinence rates are, however, higher than in patients without prior surgery for benign prostatic hyperplasia.
钬激光前列腺剜除术（HoLEP）是局限性前列腺癌（PCa）常见的手术治疗选择。本综述旨在确定HoLEP术后局限性PCa的积极治疗（根治性前列腺切除术[RP]、放疗[RT]和聚焦治疗）的安全性、功能及病理结果。
进行了一项系统综述和荟萃分析（PROSPERO注册号：CRD42024562687），检索Ovid（Medline）和Embase（爱思唯尔）数据库至2024年10月。纳入提供接受HoLEP及后续PCa治疗方式患者数据的比较性和非比较性研究，前提是这些研究报告了术后或术中并发症、病理结果以及肿瘤学或功能结果。
在检索到的1567项研究中，纳入了22项。有HoLEP病史且接受RP的患者，其勃起功能率或病理结果并不比未接受过良性前列腺增生手术的患者显著更差。然而，HoLEP患者术中并发症发生率（优势比[OR]10.78[95%置信区间{CI}2.98 - 39.03]）和尿道膀胱吻合口漏发生率（OR 7.15[95%CI 1.83 - 27.89]）更高，尿失禁发生率更低（OR 0.44，95%CI 0.30 - 0.67）。RP后的尿失禁发生率低于RT（OR 0.15[95%CI 0.05 - 0.42]）。局限性在于相关研究稀缺（尤其是RP以外的治疗），其主要为观察性和回顾性研究，且样本量较小。
在进行患者咨询和管理决策时应考虑本荟萃分析的结果，要记住既往接受HoLEP且接受RP的患者术中并发症和尿道膀胱吻合口漏更多，术后尿失禁发生率更高。我们的研究结果还凸显了进一步开展前瞻性比较研究以评估这些干预措施肿瘤学结果的必要性。
我们调查了既往接受钬激光前列腺剜除术（HoLEP）后治疗局限性前列腺癌患者的结局。我们发现HoLEP后接受根治性前列腺切除术的患者具有良好的病理和勃起功能结果。然而，术中并发症和尿失禁发生率高于未接受过良性前列腺增生手术的患者。
